Tampa Bay Adult Congenital Heart Disease Clinic presents

Heart Health through Education

Hope for Failing Hearts

Hector Fontanet, M.D., FACC

with Marie Cheine, Medical Writer 

April 28, 2005

According to the Heart Failure Society of America, heart failure is the only major cardiovascular disease

on the rise. Heart failure is a serious chronic medical condition that develops slowly due to underlying coronary

artery disease, valvular disease and longstanding hypertension. It weakens the heart muscle so that it cannot

pump blood adequately through the body.  The hallmarks of heart failure are shortness of breath, fatigue

and swelling. Heart failure is life threatening. Approximately 250,000 Americans die from heart failure

of the pumping chambers yearly. One of the most dangerous complications of heart failure is the development

of irregular heart rhythms (even with the use of medical therapy).  When heart rhythm becomes rapid

(ventricular tachycardia) or chaotic (ventricular fibrillation) the heart suddenly stops beating (cardiac arrest). 

This condition is known as sudden cardiac death. Statistics show that sudden death is the terminal event in 30-50%

of patients with heart failure. The estimated out-of-hospital cardiac arrest survival rate is 49% in cities

where defibrillation can be provided within five to seven minutes.  However, with each passing minute

without treatment, chances of survival decrease. For the five million Americans who live with heart failure

there is a new implantable cardioverter-defibrillator (ICD) therapy that has shown better outcomes and a

significant decrease in the risk of sudden cardiac death. 

Up until recently ICDs were implanted only in the highest-risk patients who have survived an episode of cardiac

arrhythmia or sudden cardiac death. An ICD is an electronic device that is implanted surgically

(similar to a pacemaker) that monitors heart rhythm and can deliver powerful shocks to the heart to correct

life threatening abnormal rhythms. In January of this year, The New England Journal of Medicine published

 the results of a landmark clinical trial, The Sudden Cardiac Death in Heart Failure-Trial, ( SCD-HeFT) which

has shown that ICD implant therapy reduces all-cause mortality in heart failure patients by 23% when

compared to placebo. (The absolute reduction in risk of death is from 36% in five years to 28%).

Living with heart failure requires modification in lifestyle and careful monitoring by a physician.  Because

of nighttime sleep interruptions due to shortness of breath and coughing, patients must plan rest times

during the day. Close attention must be paid to sudden changes in condition such as sudden weight gain

of 3-5 pounds per day, increased swelling, pain in the abdomen, rapid heart beat or loss of appetite.

Patients must weight themselves daily, avoid stress, exercise moderately according to specific

physician recommendations, take prescribed medications faithfully, follow specific individualized plans

for food and liquid intake, and follow up regularly with a physician.

Comprehensive Heart Failure Clinics such as the one at Florida Medical Clinic have been developed

to improve quality of life. Studies have proven them helpful in assisting patients manage their heart failure,

have shorter hospital stays so that they can more quickly return to their homes and often can avoid hospital

admissions by offering treatment in a more comfortable out-patient setting.

Managing heart failure is one of the more difficult tasks facing the medical community.

The American Heart Association estimates 500,000 new cases of heart failure are diagnosed each year. 

The results of this landmark study (SCD-HeFT) have shown that ICD shock therapy improves survival beyond

the available state-of-the-art medical treatments currently used.  The medical community is now one step closer

to conquering the final cardiac frontier. Further information about living with heart failure

can be found at www.americanheart.org.

Source: New England Journal of Medicine

               American Heart Association