Tuesday, February 28, 2012

Treating Heart Failure in the 21st Century

featuring Q&A with physicians at the Mass General Heart Center



In this fourth and last discussion about heart health during American Heart Month, Kimberly A. Parks, DO, MGH Advanced Heart Failure and Transplantation, Jagmeet P. Singh, MD, PhD, Cardiac Resynchronization Therapy Program Director and Sean Ming-Yuan Wu, MD, PhD, assistant physician, talk about heart failure.  This type of heart disease affects almost six million people in the U.S.  Modern treatment options, however, are helping patients stay alive.


What are your thoughts on American Heart Month?  Is there enough awareness about heart disease in our country, or is more education aimed at patients and the general public needed?

Dr. Wu: There has been increasing awareness about heart disease in our country over the past 40 years. Efforts at prevention of heart disease by greater publicity and education to the community along with improvements in the diagnosis and treatment of heart disease have lead to a dramatic decline in the rate of death from heart diseases in the past 40 years. However, there is more that can and needs to be done since significant differences in the survival from heart disease between men and women and between different ethnic groups and social economic status continue to exist.  Having a designated month like February as the American Heart Month helps raise greater awareness of heart disease among all segments of the population.

What is heart failure?  How would someone know he or she is having heart issues like heart failure?

Dr. Parks: Heart failure is a condition in which the heart is no longer able to pump enough blood to keep up with the body's requirements.  It does not mean that the heart has stopped working, but the heart has stopped working as well as it once did. Heart failure can be the result of a weakened heart, such that the heart pumping function is no longer strong enough to adequately pump blood to the tissues. It could also be the result of a stiffened heart, such that blood "backs up" into the lungs and other organs.  When a person has heart failure, there are a number of symptoms that they may experience.  The symptoms of heart failure may include: fatigue, dizziness, shortness of breath, swelling in the legs or ankles, abdominal discomfort and fullness, difficulty sleeping because of shortness of breath, reduced exercise capacity.

How many people in the U.S. have heart failure, and what are the demographics of the average person with this condition?

Dr. Parks:  In 2010, there were approximately 5.8 million people in the United States with the diagnosis of heart failure. Each year, approximately 670,000 people are diagnosed with heart failure and more than 290,000 deaths are associated with the disease.  It is more common in people over the age of 65, and it is the number one reason why people over age 65 are hospitalized.

Are there ways people can help prevent getting heart failure or other types of heart disease?

Dr. Parks: In some cases, heart failure is not preventable, but it can be treated.  There are many risk factors that can ultimately lead to heart failure, and in many cases, heart failure can be prevented. It is important for people to understand the risk factors for development of heart failure and heart disease.  The following are ways that you can best decrease your risk of developing heart disease and ultimately heart failure:

-          maintain a healthy weight

-          exercise regularly

-          abstain from smoking

-          make sure that your blood pressure is well controlled

-          maintain a cholesterol level that is at an acceptable goal

-          if you have diabetes, make sure that your blood glucose is under good control

-          do not drink alcohol in excess

What treatment options are available for heart failure patients?  Are there new types of treatments being used now or ones being researched for future use? 

Dr. Parks: There are many new treatments available for patients who have heart failure. For those with advanced disease there are “heart pumps,” or left ventricular assist devices (LVAD). These devices do not replace the heart, but they help the heart do its job by restoring normal blood flow. A total artificial, “mechanical” heart is available in clinical trials. For those patients with less severe disease, there are many novel treatments ranging from medications to implantable devices; there are sensors that can be implanted in the heart to help your doctor determine which medications are most appropriate based on assessing the internal pressures of the heart.  There are also special types of pacemakers that can dramatically improve symptoms, and in many cases, can improve the heart muscle function.

Dr. Singh:
On the implantable device front, there are many therapies which are currently available and many more that are coming down the pipeline. The central theme of these therapies is to save lives and make patients feel better by improving the strength of their heart. We routinely implant defibrillators in patients who may have a high risk profile for life-threatening heart rhythm disorders. On the other hand we implant specialized forms of pacemakers, known as cardiac resynchronization devices, which help improve the heart function in a substantial number of patients who don’t respond adequately to drug therapy. As eluded to by Dr. Parks, newer devices with novel sensors are now available that can be implanted in the heart and give us real-time measurements of pressures inside the heart, which allow us to treat our patients in a more ‘individualized’ manner. We are working on a slew of newer devices which can regulate the nerves that supply the heart and by pacing and modulating these we can potentially help strengthen the heart and reduce the symptoms of heart failure. These therapies at this juncture are investigational.  This is a very exciting area and we are fortunate to be on the very cutting edge and to have the opportunity to improve the quality and length of our patient’s lives.

There’s a lot of talk about stem cell therapy.  What are MGH researchers doing to explore heart regeneration?

Dr. Wu: There have been remarkable advances in stem cell biology in recent years that we would not have imagined 10 or even five years ago. These advances build on previous research efforts in the 1970s to 1990s that have led to the development of blood stem cell transplantation as therapy for pediatric and adult cancer treatment. With stem cells, we now have the means to generate nearly any cell type found in the body and these stem cells can be custom made from any patient's own blood or skin cells. The ultimate goal of stem cell research is to identify a cure for all kinds of heart diseases whether it involves using stem cells to understand the disease process or to generate replacement cells for transplantation. Background on a potential way where stem cells can be use to recreate a living heart was featured in a recent PROTO article which featured Harald Ott, MD, an instructor in surgery at MGH. While it will be some years away before stem cell therapy can make an impact on heart disease, we believe the investment in time and efforts now to study stem cells will be richly rewarded in the future with improved therapy for heart failure, heart rhythm disorder and congenital heart disease affecting young children.


For more information about heart health, visit the Heart Center’s page.


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