My Adventures with Heart Failure

This week's news articles:
First, as the overweight, couch-potato, baby-boom generation starts edging into the "normal" age range where heart failure becomes more common, what a surprise! Heart failure rates increase! What is of note, regardless of age, here, is that survival rates are improving - finally! We were getting tired of those mortality statistics not budging, despite newer meds and newer surgeries. Finally, it appears, the cumulative effects of those things are having an effect on mortality.

Heart failure increasing in older adults
Feb 08 (Reuters Health) - The rate of heart failure in the US among older adults increased from the 1970s to the 1990s, but survival rates have improved, new research shows. Both of these trends were more apparent in men than in women.
"Hospitalizations for heart failure have more than doubled between the two periods," Dr. William H. Baker, from the University of Rochester in New York, said in a statement. "Heart failure is the most common discharge diagnosis for men and women over age 65."

The findings, which appear in the American Heart Association's journal Circulation, are based on study of new cases of heart failure in the early 1970s and 1990s using data for more than 300,000 older adults enrolled in an HMO in Oregon or Washington.

From 1970 to 1974, a total of 387 patients were diagnosed with heart failure. The number of new cases from 1990 to 1994 was 1555. After accounting for age, a 14 percent increase in the rate of heart failure was observed between the two periods. As noted, this rise was greater in men than in women.

Deaths due to heart failure fell during the 20-year period by 33 percent for men and by 24 percent for women, the report indicates.

As to why survival did not improve as much in women, the researchers believe that it may be because older women have more additional diseases than men or because they are more physically frail.

"The increase in incidence and survival for heart failure suggests an accelerating rise in this disabling and costly disease that is of public health and clinical importance," Baker emphasized. "In the future, heart failure deserves the highest research priority into its precipitating factors and its management."

SOURCE: Circulation, online February 6, 2006.

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Next, a reminder to us all that we should have our kidney function checked regularly.

Poor kidney function ups death risk in heart failure

Feb 07 (Reuters Health) - Impaired kidney function raises the risk of death and hospital admission in patients with chronic heart failure, even among those patients with fairly well preserved heart-pumping action, study findings suggest.
So-called "renal insufficiency" has been shown to increase the risk of death in chronic heart failure patients, but most studies have involved patients with markedly reduced left ventricular ejection fraction (LVEF) -- a measure of the heart's blood-pumping strength.

Less is known about the impact of kidney function on heart failure in the presence of preserved heart-pumping power.

To investigate, Dr. Hans L. Hillege, from the University of Groningen in the Netherlands and associates studied 2,680 heart patients -- 1087 of whom had an LVEF greater than 40 percent indicating preserved heart-pumping action.

At baseline, 36 percent of patients had poorly functioning kidneys. During a median follow-up of 34.4 months, 950 patients died of cardiovascular causes or were admitted to the hospital for heart failure, and there were 625 deaths from all causes.

The authors report that both poorly functioning kidneys and lower LVEF were significant independent predictors of worse outcomes.

"The strong independent effect of renal function in our analysis after adjustment for numerous cardiac risk factors shows that renal function is a valuable predictive variable in evaluating outcomes," the authors maintain, "even if it probably represents partly underlying atherosclerotic or hypertensive vascular disease."

SOURCE: Circulation, February 6, 2006.