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Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
July
20, 2009
New Research Challenges Old Assumptions About Heart Failure
Treatment and Disease Management
Journal Highlights Latest HF Research Findings
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.
Study Highlights
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.
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The American College of Cardiology is leading the way to optimal
cardiovascular care and disease prevention. The College is
a 36,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
the American College of Cardiology as a service to physicians,
the media, the public and other interested parties. However,
statements or opinions expressed in these reports reflect
the view of the author(s) and do not represent official policy
of the ACC unless stated so.
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