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Despite steady progress in management of heart failure and treatment of those who have it, some conditions have persisted as clinical challenges. For example, sudden death remains hard to predict and even harder to prevent among patients with heart failure. A highlighted report from Heart Failure Update 2002 shows how this long-challenging condition is finally yielding to recent medical advances.
“Over the years, we have managed to handle worsening heart failure [with pharmacotherapy], but we have not managed to lessen sudden death,” remarked Prof. K. Swedberg (Sweden). The 2-year mortality rate for patients with severe congestive heart failure still remains at 50%. Most of these deaths are attributed to cardiovascular causes—with sudden death responsible for at least half. Worsening heart failure accounts for only 30%, and myocardial infarction underlies fewer than 10% of deaths. Given the high rate of sudden cardiac death (death within 60 minutes of the onset of new symptoms), it is important to identify underlying causes and predict which patients are most vulnerable. As summarised by Dr. Swedberg, results of recent trials suggest that arrhythmias—including both tachycardia and bradycardia—are common among heart failure patients who die sudden deaths. In fact, measurement of heart rate variability with a Holter monitor appears to be helpful for identifying patients at risk for sudden death and for assessing disease progression over time. Research investigations show that cardiac resynchronisation therapy (CRT; also known as biventricular pacing) can correct irregular heart rhythms by decreasing prolonged delays between the onset of left ventricular and right ventricular contraction. Promising clinical studies have provided evidence that CRT improves patient quality of life, increases 6-minute walking distance, lowers NYHA classification, decreases QRS duration, and increases left ventricular ejection fraction. New findings described in Oslo further demonstrate that CRT can reduce rehospitalisation rates, decrease ventricular remodelling, and increase survival to 85% at 2 years. CRT devices appear to be beneficial to patients who are at greatest risk for sudden death—including those with moderate to severe heart failure (NYHA II-IV), impaired left ventricular ejection fraction (< 35%), and prolonged QRS (> 120 msec) despite ongoing conventional pharmacotherapies. Although benefits of CRT are substantial, not all patients respond to this therapy; further studies are thus needed to distinguish patients most likely to be “CRT-responders” from the “CRT-nonresponders.” For more information on this topic, see this recent review article: |
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©2002 Failinghearts.com |
