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Treatment Advances Improve the Odds for Heart Failure Patients
Date:2/16/2012

By Alan Mozes
HealthDay Reporter

THURSDAY, Feb. 16 (HealthDay News) -- Although a growing number of Americans now struggle with heart failure, experts say new treatments have dramatically improved both quality of life and life expectancy for these patients.

"The present environment for heart failure is substantially improved, and the future holds promises that will truly remove the term 'failure' from the description of this illness," said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles and co-director of the Preventive Cardiology Program at UCLA's David Geffen School of Medicine.

Dr. Clyde Yancy, past president of the American Heart Association and chief of cardiology at Northwestern Memorial Hospital in Chicago, seconded that notion, pointing to what he sees as "the edge of a new dawn" in which advances in treatment will enable clinicians to "take the heft, the drama and the 'failure' out of heart failure."

To raise public awareness, the American Heart Association has deemed this week National Heart Failure Awareness Week.

A little understood medical condition, the symptoms of heart failure include extreme fatigue, weakness and/or shortness of breath, as years of poor nutrition, inactivity, high blood pressure, high cholesterol, excessive weight and related health complications, such as diabetes, take a cumulative toll on an ever-weakening heart.

In turn, the heart muscle strains, and ultimately fails, to carry out its continuous duty of pumping blood (and the oxygen it carries) throughout the body. This makes everyday acts such as walking or climbing stairs a major effort for patients. Heart failure is now estimated to affect 6 million men and women in the United States.

"Anybody in the population over the age of 40 has a 20 percent chance of developing heart failure, regardless of your medical history," Yancy said. "Which means, in short, that all of us are at risk. And of course those with a history of heart disease have an even higher risk."

However, Yancy noted, "just a few years ago we had nothing we could say that was particularly encouraging. It wasn't a disease for which there was much hope or optimism. But that has totally turned around now."

Why?

Fonarow credits the shift to a decade of drug and medical device innovation. On the one hand, there is the advent of whole new classes of medications -- such as ACE inhibitors, beta blockers and aldosterone antagonists -- that help lower the risk for developing heart failure, while expanding treatment options when it does strike.

And, Yancy added, "We also know that cardiac rehabilitation -- namely an exercise regimen -- can also help. Years ago, we told patients to just take it easy. But, now we know that an active vigorous lifestyle is actually a better way to go."

At the same time, Fonarow pointed to the rise of small, affordable and effective implantable electrical devices that have helped physicians better control the sort of electrical disturbances of the heart that can harm normal function.

"Even for the patient with far advanced disease, the utility of mechanical support -- artificial heart pumping devices -- has become remarkable," Fonarow noted. "We can sustain patients for a time sufficiently long enough to not only allow for heart transplantation, but also to serve as definitive therapy and, even more provocatively, to support recovery of heart muscle function."

The result: over the past decade heart failure hospitalizations have actually declined, while the risk of death has plummeted 65 percent to 80 percent, Fonarow said. "What was once a dismal and depressing diagnosis, with an over 50 percent five-year mortality rate, is now a clinical scenario for which optimism and new hope emerges."

The future of heart failure treatment looks even brighter, said Yancy, given developments now under way that revolve around protein, gene and stem cell transplantation therapies designed to help patients recover more fully after a heart attack.

"It is a reality that will take some more time to be fully realized," Yancy noted. "But it is assuredly coming down the road."

That said, he admits that the status quo is not entirely rosy, given that U.S. hospitals now see roughly 500,000 new heart failure patients come through their doors each year.

The key to lowering that number: helping the public connect the dots between an unhealthy lifestyle and harm to the heart.

"For many people, heart failure is a fuzzy disease," Yancy noted. "People commonly think about their risk for a dramatic event, like a heart attack. But heart failure needs to be on everyone's consciousness because it develops quietly over time, as the heart gets weighed down by burdens such as obesity, diabetes and smoking," he explained.

"So, it's important to galvanize the public so that everyone knows that heart failure can be treated, but also prevented," Yancy said. "Because even though we can't cure it, we do know how to handle it. So, we can't approach it as if it's an inevitability. Because it's not."

More information

For more on a heart-healthy lifestyle, visit the American Heart Association.

SOURCES: Gregg C. Fonarow, M.D., professor, cardiovascular medicine and science, director, Ahmanson-UCLA Cardiomyopathy Center, and co-director, University of California, Los Angeles Preventive Cardiology Program, David Geffen School of Medicine; Clyde Yancy, M.D., past president, American Heart Association, and chief, cardiology, Northwestern Memorial Hospital, Chicago


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