Posts Tagged heart failure
Heart Failure Hospital Admissions Continue to Rise
The number of Americans admitted to hospitals for heart failure has jumped in recent years, and the trend almost certainly will continue, says a report in the Journal of the American College of Cardiology.
“Our study covers more than two decades, from 1979 to 2004, and the number of hospitalizations almost tripled during that time,” says Dr. Jing Fang, an epidemiologist with Centers for Disease Control and Prevention (CDC).
A major reason for the increase is the aging of the American population, says Dr. Fang. Heart failure, in which the heart progressively loses its ability to pump blood, is more common among older people.
“Another reason is the improvement in technology for treatment of patients with other heart diseases, such as acute myocardial infarction [heart attack],” adds Dr. Fang. “So, people with diseases of the heart live longer.”
Therapy Limited for a Declining Heart
The National Heart Discharge Survey shows that the number of admissions to hospitals with any mention of heart failure rose from over one million in 1979 to nearly four million in 2004, the report says.
More than 80 percent of those admitted to hospitals were 65 or older, with Medicare or Medicaid covering the cost.
The report did not cover the cost of the hospitalizations, but the American Heart Association has estimated it to be more than $20 billion annually, says Dr. Fang.
There has been a marked increase in the number of hospitalizations for which heart failure was not the primary cause.
Heart failure was listed as the primary cause in no more than 35 percent of cases, with respiratory diseases and other conditions given as the reason for hospital admission in all other cases.
“Most are due to pneumonia or another disease that makes heart failure worse,” says Dr. Fang.
Better control of those other conditions, which include diabetes and kidney disease, could reduce hospitalizations for heart failure.
But those people tend to keep coming back to the hospital because “you cannot cure people with heart failure,” explains Dr. Fang. “The best medicine [we] can do is to keep the heart functioning enough for the patient to have good quality of life.”
Hospital-Based Care Could Improve
A basic problem is that there is no effective treatment for heart failure severe enough to cause hospitalization, says Dr. Javed Butler, director of the heart failure research program at Emory University in Atlanta, and co-author of an accompanying editorial.
“When you are talking about medications that have been proven, they all are for chronic, stable outpatients,” explains Dr. Butler. “We don’t have any proven medications for treatment in the hospital.”
What is needed is a major effort to develop in-hospital treatments for severe heart failure, he says.
“When you consider the huge cost, it is right up high on the list of conditions we need to study,” says Dr. Butler. “It is a least-studied, most costly problem. We need to get a better grasp on what we should be doing.”
Always consult your physician for more information.
Online Resources
(Our Organization is not responsible for the content of Internet sites.)
Centers for Disease Control and Prevention (CDC)
Heart Failure Society of America
Add comment October 9, 2008
Heart Failure a Concern for Non-Cardiac Surgeries
Older persons with heart failure face heightened odds of complications and death after non-cardiac surgeries, according to a study reported in the medical journal Anesthesiology.
“We’re trying to draw attention to this major problem,” says lead researcher Dr. Adrian F. Hernandez, at Duke University.
Heart failure, the progressive loss of the heart’s ability to pump blood, is widespread among older Americans, but it sometimes is overlooked as a risk factor when surgery is needed, he says.
“Most physicians focus on whether [older patients] have coronary artery disease or have a risk of heart attack,” says Dr. Hernandez. “Heart failure is by far a more important risk factor, but it doesn’t usually have greater weight when they want to identify patients at risk of complications or consider how they want to treat them after surgery.”
Symptoms of heart failure include shortness of breath, fatigue, and swelling of the legs.
Condition Has Impact on Surgery Success
Dr. Hernandez used Medicare data on more than 159,000 people undergoing major surgery not involving the heart, such as hip replacement operations. The study was the largest one ever conducted on this issue.
Past estimates have put the incidence of heart failure in the older population between 5 percent and 12 percent, but the new study found the condition in almost 20 percent of those having surgery.
The study divided the participants into three groups: those with heart failure, with or without coronary artery disease; those with only coronary artery disease; and those with neither condition.
Nearly 98 percent of all those who had surgery were discharged soon afterward from the hospital.
But 17.1 percent of those with heart failure had to be re-hospitalized within 30 days, compared to 10.8 percent of those with coronary artery disease and just 8.1 percent of those with neither ailment.
In the month after having surgery, 1.6 percent of those with heart failure died, compared to 0.5 percent for those with coronary artery disease and 0.3 percent of those with neither condition.
Steps can be taken to reduce the toll, notes Dr. Hernandez.
“The first thing is to check on what the conditions are that might influence the patients’ outcomes,” he says. “We have to identify therapies that lower the risk of a poor outcome and assure that all patients, when they have surgery, are carefully monitored.”
Close attention should be paid to be sure that symptoms of heart failure are kept to a minimum, adds Dr. Hernandez. Medications such as beta blockers and diuretics can be used to keep heart failure under control.
But he notes that it is not certain how effective such measures might be in reducing risks – only a rigorous, controlled study could answer that question definitively.
Steps Can Be Taken to Reduce Risks
Dr. Robert Hobbs, a cardiologist at the Cleveland Clinic, says the increase in surgery risk due to heart failure has been noted before, but “this is a big study that involves a lot of people. It solidifies that the risk is real, and the risk is substantial.”
Measures that can be taken to reduce the risk include simply not performing surgery, if possible, on someone whose life might be endangered, says Dr. Hobbs.
“If surgery is necessary for someone with heart failure, there should be targeted use of heart failure medications before the operation and an effort to avoid overloading the body with intravenous fluid during the procedure,” he says.
“And we would certainly watch them more carefully in the postoperative period,” adds Dr. Hobbs.
Always consult your physician for more information.
Add comment June 1, 2008
