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More on New Ways to Treat Failing Hearts

New Ways to Treat Failing Hearts

New York (Jul 16, 2009)

Drawing of human heart

Doctors at NewYork-Presbyterian Hospital have new treatment options for patients suffering from heart failure: left ventricular assist devices (LVAD), new drugs for renal complications, and a multicenter intracoronary gene therapy trial known as CUPID (Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease).

Heart failure creeps up on people and slowly steals their breath away. At first it's difficult to catch a breath while walking, mowing the lawn, or carrying a heavy box. As the heart muscle becomes weaker or stiffer and pumps blood less and less efficiently, the lungs begin to fill with fluid, and people with heart failure find it harder and harder to breathe. Eventually they find it a strain to draw a breath even when they're sitting still.

Heart Failure is Epidemic Among Americans

Heart failure is epidemic among Americans – half a million people are diagnosed with it each year and it tops the list of reasons for hospital visits in those over 65. The good news is that current treatments have extended the life expectancy of people with heart failure, said Ulrich Jorde, MD a cardiologist at NewYork-Presbyterian Hospital. And researchers have these promising new treatments in development that could improve quality of life during those years.

Repeat Heart Attacks Are Primary Cause

"Repeat heart attacks cause most cases of chronic heart failure," said Dr. Jorde. "Each attack takes out pieces of the heart muscle, kind of chop by chop. At a certain point the heart is so weak that you have problems going forward." As the condition progresses other organs suffer. "The real problems arise when the heart cannot do its job and the other organs, specifically the kidney, begin to fail. That's when you're going down the road," he said.

Therapies for Heart Failure

To slow the progression of heart failure cardiologists use three basic treatment approaches:

  • Medications including ACE inhibitors, diuretics, vasodilators, beta-blockers, calcium channel blockers, potassium, and cholesterol lowering drugs
  • Pacemakers
  • Surgical interventions including valve surgery, coronary artery bypass grafting, heart transplant, and the implantation of heart pumps called left ventricular assist devices (LVAD)

These therapies have extended the life expectancy of most people with chronic heart failure, and the annual death rate in patients with most advanced heart failure has fallen from 52 percent to less than 20 percent in the past decade. "Patients are living longer, but often live for years with very weak hearts," said Dr. Jorde, "and eventually they become maxed out on therapies." Doctors at NewYork-Presbyterian's Columbia Center for Advanced Cardiac Care specialize in seeing patients at this stage of the disease.

"When people come to see us they usually have failed standard therapy or they are not doing well for some other reason. Our first step is to make sure that the standard therapies have been appropriately employed – and two of three times that's the case. Patients at this stage of the disease have fewer treatment options, so it is critical that they see a specialist who is up to date and who offers the full range of available therapies," Dr. Jorde said.

Heart Transplants and LVAD's

A heart transplant is an option for some patients, and NewYork-Presbyterian performs more transplants – between 80 to 120 each year – than any other center in the country. But the number of transplants has remained steady at about 2,000 each year in the US over the last decade while the ranks of heart failure patients has grown. "There is a significant donor shortage," Dr. Jorde said.

Patients waiting for a transplant – and even some patients who are not good transplant candidates – may be eligible for a mechanical LVAD pump. Researchers at NewYork-Presbyterian are testing the new generation of LVADs in clinical trials. These are significantly smaller than the first generation of pumps, which gives them several advantages including a much lower risk of infection and a longer life span.

Saving Kidneys and a New Clinical Trial

NewYork-Presbyterian researchers are also testing new medications that may improve kidney function in patients with kidney damage due to heart failure, and they are also participating in a gene therapy study, known as CUPID, that is designed to resupply the heart with a gene that produces an enzyme called SERCA2a, which is central to heart muscle contraction. "This is really investigational at this point, but we believe it is safe," Dr. Jorde said.

Donna M. Mancini, MD is the contact for the gene therapy clinical trial.

Ulrich Jorde, MD is an Assistant Attending Physician at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Assistant Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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