Congestive Heart Failure: Key Q&A

What is congestive heart failure?
Congestive heart failure is a serious condition in which the heart's pumping action is compromised. In the early stages, heart failure may not have any symptoms. In the later stages, you may have severe symptoms because your weakened heart is unable to pump enough oxygen-rich blood with each contraction to satisfy the body. These symptoms may include shortness of breath, or dyspnea, that initially occurs only during exercise, and later even while at rest.

How common is congestive heart failure?
According to the American Heart Association, heart failure affects about 5 million Americans, with more than half a million new cases diagnosed every year. Interestingly, while the incidence of other cardiac diseases remains stable or varies only slightly, the incidence of heart failure has increased significantly over the last three decades. This is because of the aging population and doctors' increased ability to treat other cardiac diseases. In the 1970s, high blood pressure was the leading cause of heart failure. Today, because of the increased survival due to treatments such as bypass surgery and balloon angioplasty, coronary artery disease is the leading cause of the condition.

How dangerous is congestive heart failure?
It is a very serious condition. According to statistics from the American Heart Association, there are about 5 million heart failure patients in the United States, and 550,000 new cases of heart failure are diagnosed in the United States every year. This includes 10 out of every 1,000 people over the age of 65. Of newly diagnosed patients under the age of 65, about 80 percent of the men and 70 percent of the women will die within eight years. In people diagnosed with heart failure, sudden cardiac death occurs at six to nine times the rate of the general population. The earlier the condition is diagnosed and treatment begins, the better your prospects for an improved quality of life down the road.

Does race have an impact on congestive heart failure?
Yes. Comparing the incidence and course of heart failure between Caucasian and black Americans is provocative. Studies have found that, in Caucasian patients, heart failure most often occurs as a result of coronary artery disease, such that this condition develops directly into systolic heart failure. Black Americans, however, tend to progress more gradually from hypertension, or high blood pressure, to heart-wall thickening, to diastolic heart failure and finally to systolic heart failure. Statistics also show black American heart-failure patients to be younger and more likely female, as compared to Caucasian patients. In addition, black Americans with heart failure are more likely to be diagnosed with hypertension and diabetes. While some studies have shown that black Americans have higher heart failure mortality rates than whites, other studies have shown similar survival rates between the two racial groups. The reasons for these differences are still being investigated.

What treatments for congestive heart failure may soon be available?
A variety of new therapies are currently being studied for use in treating heart failure. They include vascular endothelial growth factor, a total artificial heart, a heart jacket and heart-valve repair. Vascular endothelial growth factor is a medication that can be injected directly into the heart or intravenously. In studies, it has shown some promise in the production of new blood vessels. Research is ongoing.

The Food and Drug Administration has approved clinical trials for a fully implantable, total artificial heart. The grapefruit-size device is powered by a battery that can be recharged from outside the body without the need for tubes to pass through the skin. Subjects of the study are end-stage heart-failure patients who are not eligible for a heart transplant, cannot be helped by other available therapies and are at imminent risk of death.

A heart jacket is a synthetic, elastic material that is surgically attached and wrapped around the heart surface. The meshlike fabric supports the ventricles, providing a snug fit but without constricting the heart. The goal is to reverse remodeling of the left ventricle. Remodeling was assumed to be irreversible, but recent successes with beta blockers and ventricular assist devices show that remodeling can be improved. In earlier animal studies, and now human studies, the heart jacket support device demonstrated that it does more than keep the left ventricle from enlarging. It can actually reshape and restore it to a more normal form. This led to a significant decrease in the self-destruction of heart muscle cells ‑- another hallmark of heart failure. There was a rise in cardiac output. Even with the success of the device so far, it is expected that patients receiving heart jackets would continue their medications, such as beta blockers.