A Major Health Care Problem for the 21st Century
Congestive heart failure (CHF) is a growing cardiovascular problem in the United States today. According to the American Heart Association, 5.7 million Americans currently suffer from CHF, and another 400,000 patients are diagnosed annually. The AHA also predicts that the number of cases will increase; due to the fact that many patients, who survive acute myocardial infarctions (heart attacks) because of today's advanced technology, will go on to develop CHF.
With a mortality rate of approximately 50% at five years after diagnosis, CHF is an important cause of death in our country. Nearly 300,000 Americans will die of CHF this year. In addition, among hospitalized patients over 65, CHF is the leading hospital admission diagnosis. In 2006 alone, it accounted for 1.1 million admissions to the hospital in the United States. An estimated 35% of chronic CHF patients are admitted to the hospital one or more times a year - 80% of men and 70 percent of women under the age of 65 who have Heart Failure will die within 8 years.
These factors make CHF an important health care issue, from the standpoint of disease and death, as well as the cost of caring for these patients in the hospital. Many patients are on multiple medications and often require parenteral inotropic agents in addition to extensive invasive procedures, both for diagnostic and therapeutic purposes.
In years gone by and even today, some physicians have regarded CHF as a dead-end diagnosis, since the underlying cause was thought to be irreversible in most cases. This, it turns out, is not the case. Effective medical treatment of CHF depends on the appropriate use of medications that have been shown to reduce mortality and need for hospitalization for CHF. However, effectiveness depends on the early and proper use of these drugs, which include ACE inhibitors and beta-blockers.
In the evaluation of patients with CHF, careful attention should be paid toward the possibility of myocardial ischemia (heart muscle blood deficiency) as a cause of the disease or a cause of worsening symptoms.
Surgical management is another key tool in the treatment of some patients with this life-threatening illness. It has been shown that patients with multi-vessel coronary artery disease, who have impaired left ventricular systolic function, benefit more in terms of improved survival with surgical rather than medical therapy for coronary artery disease. Therefore, in the appropriate patient, surgical myocardial revascularization (bypass surgery) should be considered for the relief of angina and CHF symptoms and to improve survival.
Cardiac transplantation is another accepted form of therapy for appropriately screened patients with end-stage heart failure who have less than six months or a year to live. Statistics show that patients who have successful cardiac transplantation go on to resume productive lives. However, patients must be carefully selected for this procedure since it is very costly, and there is a shortage of donor organs. Your doctors at Florida Heart Group are part of the cardiac transplantation program at Florida Hospital.
How should the CHF patient be managed?
First, effective treatment is based on a complete cardiovascular history and physical examination. Identification of the cause for the patient's heart failure, particularly if it is a reversible one, often can be made at this time.
Second, appropriate laboratory and diagnostic studies should be performed promptly to define the cause and severity of the disease.
Finally, as a result of the above, cause-specific treatment can be directed toward this problem.
In most cases, consultation with a cardiologist should be obtained, particularly for those patients with unexplained heart failure, new onset of CHF, or difficult to manage patients, either because of intolerance to standard therapy or because of apparent ineffectiveness of standard therapy.
Since heart rhythm disturbances are an important cause of death in this group, they should be appropriately screened for in these patients. A cardiologist can be of particular help in choosing the appropriate screening study and in recommending more extensive testing, such as electrophysiologic study.
Frequent office follow-up for these patients is key toward assessing changes in functional status and to make adjustments in medications with goal being to avoid costly hospitalizations and make the patient as functional as possible.
All of these things should be done with the main goal of avoiding the emotional and financial strains of hospitalization. A close working relationship between the patient's primary care physician and cardiologist is essential toward accomplishing this goal.