My Adventures with Heart Failure

This week's article:

Blood pressure may help predict heart failure risk
Nov 20 (HealthCentersOnline) - A simple vital sign taken during admission to the hospital may be able to predict whether a patient's heart failure will worsen, according to a recent study.
Heart failure is a chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body's needs. This leads to congestion in the lungs or pulmonary blood vessels and may cause fluid backup or swelling in the lungs, legs and ankles.

Blood pressure is a measure of the force, or tension, of the blood against the walls of the arteries. The higher this measurement, the higher the workload and strain on the heart. Blood pressure is expressed as systolic pressure over diastolic pressure.

Researchers from several universities have found that heart failure patients with a higher systolic blood pressure appear to have a lower risk of dying when compared to heart failure patients with lower systolic blood pressure. The study also found that a lower systolic blood pressure in a heart failure patient may indicate advanced disease as well as a poorer prognosis.

For the study, the researchers analyzed patient data from a large heart failure patient registry known as the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). This registry includes data gathered from some 48,612 heart failure patients seen at 259 U.S. hospitals.

After studying the data, the researchers found that there was a 7.2 percent mortality rate for heart failure patients with systolic pressure of less than 120 mmHg, while heart failure patients with pressures between 120 and 139 mmHg (considered the normal range) had a 3.6 percent mortality rate. Patients who had systolic pressures between 140 and 161 mmHg had a 2.5 percent mortality rate and patients with high systolic pressures over 161 mmHg had a 1.7 percent mortality rate.

Because a patient's blood pressure reading is a vital sign that is always taken during admission to the hospital, the researchers are confident that this new research may lead to a simple way to identify those patients most at risk for worsening.

"Systolic blood pressure taken at hospital admission was a strong independent predictor of mortality and morbidity in this large, representative heart failure patient population. We hope the findings may help clinicians more effectively stratify risk and offer more targeted treatments based on a patient's systolic blood pressure level," explained Dr. Gregg C. Fonarow, The Eliot Corday Chair in Cardiovascular Medicine and Science, principal investigator and director, Ahmanson-UCLA Cardiomyopathy Center, in a recent press release. The results of the study were published in the November 8 issue of the Journal of the American Medical Association.

My local newspaper (the Baltimore Sun) had an article a few days ago entitled "Working on MRIs that are safe for pacemakers." Subhead: "Patients with heart implants may be able to undergo diagnostic scanning procedure."

The article was cautiously optimistic; a study of the first pacemaker designed to withstand MRIs is scheduled to start at the end of this year. However, the article doesn't say whether this study applies to ICDs, or just plain pacemakers, and it doesn't make it completely clear whether the difference between ICDs and plain pacemakers matters for these purposes.

MRIs are used, among other things, to detect cancers.

Three magazines that might be useful (put 'em on your wish list for Chanukah/Christmas/Solstice/Festivus):

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First off, strange as it may sound, I find the magazine Diabetic Living to be very useful for someone with heart failure. Many, many of the health concerns are the same for the two chronic illnesses, including the need to watch one's weight, to get regular medical care, to be very careful in evaluating proposed treatments (especially new ones). Plus, the magazine makes a very strong effort to make all its recipes low-sodium, or at least lower-sodium, as well as low-fat and low-sugar. I've gotten several excellent recipes out of there that suited me (low-sodium diet), my dad (diagnosed as diabetic a couple years ago at age 80, and also had a heart attack a year ago) and my spouse (borderline high cholesterol). The one catch to this magazine for CHF patients is that you may want to buy it off the magazine racks in the drug store or supermarket rather than subscribe, because if you subscribe, you'll get all kinds of bulk mail advertising assorted diabetic supplies you don't need. I buy it at CVS; most national drug store chains carry it and I've seen it in Safeway supermarkets. Diabetic Living

Prevention, put out by Rodale: this one's aimed at health in general. It used to be a bit flaky - Rodale publishes a lot of stuff having to do with alternative medicine and living lifestyles that tend toward the green/off-the-grid/deeply-into-yoga stuff. And they used to be completely uncritical about alternative medicine and all sorts of supplements. However, the past few years, they have tempered it a bit toward the real world, and they do more critical evaluations of the usefulness of alternative treatments, and offer lots of helpful advice for people undergoing any kind of medical care, as well as offering a lot of ways to live a healthier lifestyle. Many of their recipes use reduced-sodium ingredients, and are pretty healthy. Prevention

Science News, a weekly newsmagazine that offers 12 pages or so of very short articles about the latest in medicine and science. Although they emphasize science in their title, they give summaries of a lot of medical news, and any time there's a national meeting of one of the big medical associations, such as the American College of Cardiology, they have an entire page with summaries of half a dozen or so of the most important papers presented at the meeting. Intended for the regular educated person, not highly technical but the editors assume you are familiar with at least the general vocabulary of science. Science News

This week's news article:

Pump, with drugs, can reverse heart failure
Nov 03 (Reuters) - A device that helps severely damaged hearts pump may be able to do what was once thought impossible -- reverse heart failure in people who are weeks away from death, British researchers reported on Wednesday.
The left ventricular assist device, or LVAD, can boost the heart's ability to function, allowing it to recover if used with the right drugs, the researchers said in a study.

Meanwhile, a second study found that statin drugs, already found to lower the risk of heart attack, stroke and other heart conditions, reduced the rate of death from heart failure by 24 percent.

The studies, published in this week's issues of the New England Journal of Medicine and the Journal of the American Medical Association, bring new hope for heart failure -- one of the most devastating chronic heart conditions.

The British team, led by heart surgeon Sir Magdi Yacoub of the Royal Brompton and Harefield Hospital and Dr. Emma Birks of Imperial College London, used the LVAD device and a combination of heart drugs in 15 patients with severe heart failure.

They said 11 of them recovered enough after about a year to have the artificial pump removed.

"I think it's going to surprise a lot of people because most of these patients had really, really severe heart failure," Birks said in a telephone interview.

"Most probably would have died in the next week or two if they hadn't had the device. So to turn that around to normal cardiac function is quite dramatic," she said.

Heart failure affects nearly 5 million Americans and another 550,000 new cases are diagnosed in the United States each year. The condition, which can be caused by high blood pressure, a virus or other factors, severely weakens the heart and causes it to swell.

More than half the people with severe heart failure are dead within two years. Usually, the only cure is a heart transplant.

TAKING ON THE STRESS

The pump -- a device made by Thoratec was used in this study -- is designed to relieve stress on the heart by vigorously pushing blood from the main pumping chamber into the body's main artery. Thoratec helped pay for the study.

The patients also were given a combination of commonly used heart drugs to shrink the heart and rebuild its muscle.

Not everyone survived implantation of the pump long enough to be helped by the drugs. Originally, 27 patients were enrolled in the study but some were excluded because too much of their heart muscle was already dead.

The researchers also excluded patients whose heart failure had been caused by a virus because there was a chance they would have improved on their own.

One of the 11 who had the artificial pump removed died immediately after surgery, a second died of cancer, and a third needed a transplant, possibly because of alcohol problems.

"Of the eight patients surviving without a heart transplant, four are working, two are retired and lead very active lives, one is a mother looking after two children, and one does not work despite a normal exercise capacity," Birks and her colleagues reported.

The therapy is risky and expensive. The chest must be opened up to implant the pump and the price tag for the surgery, including the device itself, is about $124,000.

In the Journal of the American Medical Association study, Alan Go of Kaiser Permanente of Northern California in Oakland and colleagues studied 24,598 adults, of whom half took statin drugs between January of 1996 and December of 2004.

The statins reduced the risk of death by 24 percent, they reported. Statins were designed to lower cholesterol but researchers are finding they have a range of effects on the blood vessels and possibly the heart.