Developments in Heart Failure ( HF ) ~ a review by retired cardiologist, Dr Ben van Zoelen
What is meant by the term heart failure ( HF )?
There are many ways to describe it but HF essentially means that the heart cannot pump enough oxygen-rich blood around the body.
In 1973 I started working as a cardiologist in a private hospital in the Netherlands. Bypass operations for coronary artery disease were in full swing – using stents and balloons to open up narrowed coronary arteries were not yet routine procedures. Our cardiology department had 50 beds, of which 10% were used for heart failure patients. Nowadays more than 60% of the bed capacity is used for heart failure patients. Why is that?
There are two reasons:
i) Today the prognosis of HF is better.
In 1970, 80% of HF patients died within 1 year. Now more than 50% survive for more than 5 years. It’s a pity that it’s still no better than that, but it is improving, year after year.
In the past we thought that we’d be able to treat HF better once we had medication that could be given by mouth to make the heart pump more strongly. Finally we got that medicine. And guess what? More people died when we used it.
This gave us the insight to ‘never lay the whip over an almost dead horse’; better to pamper it, calm down the failing heart and even sometimes give it a good rest by using a mechanical heart for a while.
These days, along with newly developed medicines, we use the good old beta-blocker to slow down the heart. This same group of drugs were absolutely prohibited in the years before which shows how things can turn right around in medical practice…if you just wait long enough.
ii) There are more people with HF
People are generally getting older and aging increases the chances of HF; 10-20% of people in their 80’s and 90’s develop HF.
Also these days there are more survivors of myocardial infarction, many of whom go on to develop HF later.
Better diagnostics using blood tests and ultrasound doppler studies now allow us to diagnose HF patients that would not have been picked up in the past. As we have learned more about HF we’ve also come to recognize that a stiff heart and even a “normal” heart can have HF.
There are now special pacemaker systems for HF patients. Implantation, adjustment and control of these medical devices is complex and so it needs the patient to be in hospital for a while until safely stabilized.
For all of these reasons, we’ve seen an increase in the amount of hospital beds occupied by HF patients since my early years in cardiology. But now steps are being taken to reverse this trend and we’ve developed outpatient polyclinics and remote monitoring of HF patients at home. In fact, we are looking into the possibility of having these two options at the Bewell clinic in the future.
The outlook for HF is very positive – there are thrilling new medications to come in the next few years that we hope will improve the lives of HF patients even further.
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This article is far from complete. I hope it gives you a better understanding of HF. If you have any comments please let me know. If you find I’ve used too many medical terms you don’t understand please email the clinic and it will be passed on to me.
Ben van Zoelen, retired cardiologist. member of the advisory board of the Bewell clinic.