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February 11, 2003


National Heart Failure Awareness Week: Emory Heart Failure Specialist Says Cases Of Heart Failure On Rise -- But So Is Hope

ATLANTA - According to the Heart Failure Society of America, which is sponsoring this week's National Heart Failure Awareness Week, about 555,000 new cases of heart failure are diagnosed each year in the U.S. -- and the numbers are expected to rise.

"One reason for the increase is that more people than ever before are surviving heart attacks, but they are left with damaged hearts leading to heart failure," notes Andrew Smith, MD, Medical Director of the Centers for Heart Failure Therapy at Emory and Emory Crawford Long Hospitals, where over 1,500 patients are seen for severe cardiac dysfunction.

"Our aging population is also increasing and congestive heart failure (CHF) is more common in people over 70. Congenital heart defects are another cause of heart failure. Diabetes, kidney disease, high blood pressure and alcohol abuse also increase the risk of CHF," he adds.

Dr. Smith points out that heart failure does not mean the heart suddenly fails and stops working. Instead, heart failure occurs when the heart loses some of its ability to pump blood through the body. Systolic heart failure results when the heart's ability to contract decreases - blood returning to the heart from the lungs can back up, causing fluid to leak into the lungs, a condition known as pulmonary congestion. Diastolic heart failure occurs when the heart cannot properly fill with blood because the muscle has lost its ability to relax. Symptoms of heart failure include shortness of breath, fatigue, difficulty sleeping due to breathing problems, a swollen and/or tender abdomen, loss of appetite, increased urination at night and swelling of the feet and legs.

Although heart failure can be debilitating and even fatal -- it causes almost 40,000 deaths a year in the U.S. and is a contributing factor in another 225,000 deaths -- there has been significant progress over the few years in relieving symptoms and even improving the heart's pumping abilities. "Expertise in prescribing and titrating medications in patients with CHF is key to helping many of these people maintain -- and often improve -- their quality of life for as long as possible. For example, although beta blockers were previously avoided in the treatment of heart failure, research has shown their efficacy in CHF when started at a low dosage that is steadily increased," says Dr. Smith. "And the class of drugs called ACE inhibitors has been shown to decrease hospitalizations by 30 percent. When combined with beta blockers, there is an additional 40 percent reduction. "

Emory cardiologists and researchers have the largest clinical experience in evaluating and implanting biventricular pacemakers -- devices which offer hope to many people with severe chronic heart failure. Known as cardiac resynchronization therapy, the pacemakers stimulate the heart's ventricles to beat at the same time, improving the heart's ability to increase blood flow to the body.

Emory electrophysiologists implanted the first biventricular pacemaker in Georgia in l997 and have since implanted more than 800 of the devices in patients with CHF -- more than any other medical center in the world. Documented results have included a dramatic improvement in quality of life, exercise tolerance and heart function. Although Emory performed over 85% of adult heart transplants in the state last year, the heart failure treatment and heart transplant team is seeing a significant decrease in the numbers of patients on the transplant waiting list due to improved therapy for CHF.

The American College of Cardiology now recommends that patients with ongoing heart failure symptoms be considered for referral to specialized heart failure centers. The Emory Centers for Heart Failure Therapy offer a unique program in Georgia dedicated to the treatment of patients with severe heart failure and offer not only the most advanced high tech and medical therapies, but also comprehensive patient and family education.

"Our nursing staff works with patients and their families to educate them on lifestyle changes, such as reducing salt, and monitoring their fluid status and weight daily so they can report any change in symptoms promptly. Patient education increases therapy compliance and we have seen even some of the sickest patients gradually improve, "says Dr. Smith.

Dr. Smith adds that CHF patients can find hope in the continuing research into new ways to help fight heart failure. "We are currently involved in a number of clinical trials, including a multi-center National Institutes of Health sponsored study of cardiac rehabilitation treatment strategies, " notes Dr. Smith. " We are continuing to learn a great deal about heart failure and we are committed to applying what we are learning to help our patients live the healthiest, best quality lives possible."

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