Heart failure—the heart’s lack of ability to pump enough blood through the body—affects approximately 5 million Americans and is expected to increase by 10 percent each year as the population ages. Emerging research is helping clinicians gain a better understanding of which patients with heart failure (HF) are likely to respond to treatment, as well as the importance of evidence-based disease management practices. New findings into the role of genetics, the importance of non-pharmacologic intervention and the benefits of palliative care appear in the July 28, 2009, issue of the Journal of the American College of Cardiology, which is dedicated to presenting the latest HF research.
“Heart failure has become a significant area of cardiology,” said Alfred A. Bove, M.D., Ph.D., F.A.C.C., president of the American College of Cardiology (ACC). “The challenge is that many patients don’t seek medical care until they begin to experience symptoms at later stages of the disease, clinicians may not detect heart failure at first because the heart appears to be functioning normally, and many hospitals and insurers may not support optimal HF care.”
In HF, the heart can’t pump blood properly, causing fluid buildup in the lungs and the rest of the body, leading to shortness of breath, swelling of the limbs (edema) and other symptoms. Most doctors can readily diagnose systolic HF, which is characterized by a weakened and enlarged heart and left ventricular dysfunction that prevents the heart from pumping enough blood into the blood vessels. Another type of HF, diastolic dysfunction, is sometimes overlooked, according to Dr. Bove. Here, the heart appears to be pumping normally, but the walls of the heart muscle become stiff and the heart cannot adequately relax to fill with blood between heart beats. The latter is common among older patients with a long history of high blood pressure.
“Early intervention can help reduce mortality and morbidity of heart failure, which is why it is important that patients have periodic physical exams and echocardiograms to detect it,” said Dr. Bove. “Sadly, insurers will pay for patients after they get sick again but do not always support care that can prevent exacerbations. This is troubling because patients who leave the acute hospital setting often lose access to medications and ongoing surveillance that can prevent acute problems from recurring. The result is higher hospital readmission rates and subsequently increased healthcare costs.”
Dr. Bove stresses that HF management should include ongoing patient education and communication whether it’s through home visits, doctor visits, or phone or internet reporting.
New research in HF is providing insights into how clinicians can improve HF management to address these challenges. Studies published in the current issue of JACC find:
- Genetics may trump race. According to this study, African American and Caucasian patients who share a specific genetic variation have a similar improved response to beta-blocker treatment and HF survival, while the presence of other variations may help predict poor treatment response and lower chance of survival. The data suggest that these genetic variations, rather than race, are a more important factor to consider when assessing disease prognosis and treatment outcomes. This counters previous beliefs that race is a primary factor influencing patient response to treatment and long-term survival.
- Palliative care should be part of comprehensive HF management. Researchers are calling for the integration of palliative care into the clinical management of HF to help patients and their family members cope with the disease prognosis and plan for the physical and emotional distress associated with impending mortality, reduced quality of life and overall burden of managing a long-term disease. The authors encourage the inclusion of palliative care in HF clinical trials to gain more data to support the development of evidence-based palliative care practices.
- Better evaluation of HF programs needed. Authors support the use of HF disease management programs that incorporate multi-disciplinary, non-pharmacologic interventions, but stress that these disease management programs need to be properly evaluated using recently released standards for reporting clinical care outcomes in HF patients.
“This research suggests that integrating genetic assessment of patients, providing non-pharmacologic and palliative care, and applying the principles of chronic disease management can improve treatment outcomes and reduce the mortality and the burden of heart failure,” said Dr. Bove.