July 21, 2003

Center celebrates 10 years of treating sick hearts

By Sherry Baker

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.”