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ATLANTA - The Emory Center for Heart Failure Therapy celebrates ten years at Emory University Hospital (EUH) this month -- and it is an anniversary that marks a decade of remarkable progress in treating one of America's top causes of death and disability. Nearly 5 million Americans are currently living with congestive heart failure (CHF) and approximately 550,000 new cases are diagnosed in the U.S. each year.
"This has been an exciting decade at Emory and in the field of congestive heart failure," notes cardiologist 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. "We are proud of the innovations and research at Emory that has contributed to the remarkable improvement in the prognosis for many patients with heart failure."
Founded at EUH in l993 as an extension of Emory's Adult Cardiac Transplant Program, the EUH Center was expanded in l995 to Emory Crawford Long Hospital (ECLH). Today, both Emory Centers for Heart Failure Therapy partner with Emory Clinic, Emory Hospitals and the Neil Hodgson Woodruff School of Nursing to provide a comprehensive program of care for patients with heart failure. Dr. Smith and other Emory Heart Center physicians, including Wendy Book, MD, Brenda Hott, MD and Jerre Lutz, MD, follow over 1,500 patients who have severe cardiac dysfunction and see approximately 30 new patients each month who have congestive heart failure (CHF).
The American College of Cardiology now recommends that patients with advanced, refractory heart failure symptoms be considered for referral to specialized heart failure centers and the Emory Centers for Heart Failure Therapy offer a unique program in Georgia dedicated to the treatment of patients with severe heart failure.
"Our center was designed as a referral source for patients with advanced congestive heart failure. The majority of patients that we see here have been referred by other cardiologists in the state and throughout the southeast," says Dr. Smith. "We are able to offer not only high tech and medical therapies, but also comprehensive patient and family education because of the advanced nursing care that we have available on an outpatient basis. 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 some of the sickest patients gradually improve."
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 past ten 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 dramatic 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 CHF patients -- more than any other medical center in the world. Documented results have included including improvement in quality of life, exercise tolerance and heart function.
Although Emory performed 85% of adult heart transplants in the state last year, the Emory 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, according to Dr. Smith.
"When a heart transplant is necessary, the odds are favorable that a patient will be transplanted, but some patients require mechanical assistance, " he says. "Patients awaiting the procedure may be helped with a dual pump biventricular assist device (Bi-VAD) implant, which serves as a bridge to heart transplantation, pumping blood for the left and right ventricles of the heart."
In 1999, J. David Vega, MD, Director of the Heart and Lung Transplant Program at EUH performed Georgia's first Bi-VAD implant. Over 400 adult heart transplants have been performed at EUH since 1988. One, five, and twelve year survival rates for transplant patients are approximately 92%, 80% and 60% at Emory -- placing the program well above national survival statistics.
Emory Heart Center cardiologist Wendy Book, MD, and Michael McConnell, MD, a pediatric cardiologist, work in close collaboration in the Emory Adult Congenital Heart Program, which is located within the Center for Heart Failure Therapy. The growing numbers of adults with congenital heart problems, many of whom have undergone previous operations, presents a challenge in care that requires extensive knowledge in the management of these patients.
Dr. Smith states 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 to determine if supervised exercise training will improve outcomes in our patients," 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."