The Emory Center for Heart Failure Therapy recently
celebrated 10 years at Emory Hospital—and it was an anniversary
that marked 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 United States each year.
“This has been an exciting decade at Emory and in the field
of congestive heart failure,” said cardiologist Andrew Smith,
medical director of the Centers for Heart Failure Therapy at Emory
and Crawford Long hospitals. “We are proud of the innovations
and research at Emory that have contributed to the remarkable improvement
in the prognosis for many patients with heart failure.”
Founded at Emory Hospital in 1993 as an extension of Emory’s
Adult Cardiac Trans-plant Program, the center was expanded in 1995
to Crawford Long. Today, both locations 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. Smith and other heart center physicians, including Wendy
Book, Brenda Hott and Jerre Lutz, follow more than 1,500 patients
who have severe cardiac dysfunction and each month see approximately
30 new patients with 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
offer a unique program for Georgia patients.
“Our center was designed as a referral source for patients
with advanced congestive heart failure,” Smith said. “The
majority of patients we see have been referred by other cardiologists
in the state and throughout the Southeast. 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,” he continued. “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 nearly 40,000 deaths a year in the United States and is a
contributing factor in another 225,000 deaths—there has been
significant progress over the past decade in relieving symptoms
and even improving the heart’s pumping abilities.
“Expertise in prescribing medications for patients with CHF
is key to helping many of them maintain—and often improve—their
quality of life for as long as possible,” Smith said. “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, 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 1997 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 improvement in quality
of life, exercise tolerance and heart function.
Although Emory performed 85 percent 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 Smith.
“When a heart transplant is necessary, the odds are favorable
that a patient will be transplanted, but some patients require mechanical
assistance,” he said. “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, David Vega, director of Emory Hospital’s Heart and
Lung Transplant Program, performed Georgia’s first Bi-VAD
implant. More than 400 adult heart transplants have been performed
at the hospital since 1988. One-, five- and 12-year survival rates
for these patients are approximately 92 percent, 80 percent and
60 percent, respectively, placing the program well above national
survival statistics.
Smith said 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 multicenter
National Institutes of Health-sponsored study of cardiac rehabilitation
treatment strategies to determine if supervised exercise training
will improve outcomes in our patients,” he said. “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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