Living with Heart Failure
Heart failure. The diagnosis is enough to send shivers down your spine. But with prompt diagnosis and proper treatment, many heart failure patients can survive and thrive.
“I’m the oldest Bloom that ever lived,” says Laurence Bloom of Rockport, who at 66 has topped his own expectations by six years. Especially after a heart attack at the age of 35 that led to his diagnosis.
“That was the big shock. I was thin, very active, athletic,” says Bloom. “When I got the diagnosis of heart failure, I thought it was a new term.”
It’s not, according to Dr. James D. Chang, who leads the Heart Failure program at The Cardiovascular Institute at Beth Israel Deaconess Medical Center. The diagnosis is the number one reason for hospital admissions in people over the age of 65, with about five million established cases in the United States.
Heart failure has many causes from heart attacks and coronary artery disease and heart valve problems. But it can also be triggered by long standing high blood pressure, obesity, diabetes, drug and alcohol abuse, viruses or even pregnancy.
Severity of the disease is calculated on the New York Heart Association Function Class Scale. Class 4 patients are severely ill, with shortness of breath, fluid retention and an intolerance of effort that is as ominous as the diagnosis implies.
On the other end of the scale, patients diagnosed as Class 1 have certain structural abnormalities of the heart that can often be treated simply with medication, with the patient free of symptoms.
The key, says Dr. Chang, is to treat the underlying problem – with a team effort that includes a wide variety of physicians and, importantly, nurse practitioners.
“It’s really multidisciplinary because when your heart fails, every single organ in your body is affected, because the heart pumps the blood to every single organ.”
For patients like Bloom, who suffer a heart attack, the muscle that is weakened by the cutoff of blood flow cannot repair itself. But for others – such as a woman who develops a problem during pregnancy – the damage does not need to be permanent.
“The most gratifying part of being a heart failure doctor is an appreciation I now have of the potential reversibility of heart muscle weakening and the potential reparability of heart valve problems,” says Dr. Chang.
Among those tools is the repair or replacement of the mitral valve, which regulates the flow of blood between the left atrium and left ventricle (the main pumping chamber of the heart), and which can now be performed through minimally invasive surgery.
In addition, pacemakers and devices to detect and rectify abnormal and potentially life-threatening heart rhythms are now a mainstay in the treatment of many cases of heart failure.
“In the old days, if a person had a weak heart, they were not thought to be candidates for mitral valve replacement,” says Dr. Chang. “Improved surgical technique has resulted in many new candidates for this surgical procedure.”
But medication is often the best tool, tackling the problems caused when stress or other problems can overactivate neurohormonal pathways that regulate the function of the entire cardiovascular system.
“While these pathways allow a response to stress, chronic overactivation does more harm than good and blocking activity is helpful,” says Dr. Chang. “Blocking the neuro-hormonal pathways that can be detrimental to heart function when these pathways are chronically overactive is the mainstay of medical therapy.”
But Dr. Chang and nurse practitioner Monique Nestor say the real solution to heart failure is to prevent it from developing in the first place.
“First and foremost, you identify people at risk and decrease their risk profile. People who have hypertension, known ischemic disease, known heart valve abnormalities,” says Dr. Chang. “You identify people’s risk profile and address them aggressively and proactively.”
A key element of that effort is the nurse practitioner, adds Nestor.
“Sometimes patients relate better to nurses than physicians,” she says. “Part of the training of a nurse is that we treat the whole patient, whereas physicians learn there is a disease and they try to fix that disease. We take time to answer patients’ questions and teach them about being proactive about their heart failure diagnosis.”
She says many patients “don’t make a move” without their nurse practitioner, a registered nurse (RN) who has completed advanced education and training. It is a special relationship and trust that develops between the nurse and patient.
“Most often, if patients contact me early enough, their symptoms can be improved with a few minor changes in their medications which ultimately results in patients being admitted to the hospital less. This is key. With close phone follow-up we can keep patients out of the hospital and help to improve their quality of life.
“Studies have been done that show close phone follow-up between a nurse and patient yields better outcomes such as a decrease in hospital admission and decreased costs,” she says.
For Laurence Bloom, mitral valve replacement has allowed him to do some of things he could not do as a busy attorney, such as writing and taking photographs. And Bloom, who never expected to reach the age of 60 and threw a big party to celebrate, is looking for more good years.
“When I learned that my heart worked at only 20 percent of capacity, it put a fright in me,” he says. “It took me a few years to deal with it in a positive way. Instead of being depressed and not take any risks I decided to get as much out of my life as I can. I usually don’t think about it because it would be a downer and I am a positive thinker.”
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted January 2009
