Congestive Heart Failure (cont.)
What is the long term outlook for patients with
congestive heart failure?
Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations. The course of the disease in any given patient, however, is extremely variable. Factors involved in determining the long term outlook (prognosis) for a given patient include:
- the nature of the underlying heart disease,
- the response to medications,
- the degree to which other organ systems are involved and the severity of other accompanying conditions,
- the patient's symptoms and degree of impairment, and
- other factors that remain poorly understood.
With the availability of newer drugs to potentially favorably affect the progression of disease, the prognosis in
congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.
An important issue in congestive heart failure is the risk of
heart rhythm disturbances (arrhythmias). Of those deaths that occur in patients with
congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias. A major advance has been the finding that nonsurgical placement of automatic implantable cardioverter/defibrillators (AICD) in patients with severe
congestive heart failure (defined by an ejection fraction below 30%-35%) can significantly improve survival, and has become the standard of care in most such patients.
What are the areas of new research in
congestive heart failure?
Despite the significant advances in drug therapy for congestive heart failure over the past 20 years, many exciting developments are under active study. New classes of medications are being tested in clinical trials, including the calcium sensitizing agents, vasopeptidase inhibitors, and natriuretic peptides. As was the case with the ACE inhibitors and beta-blockers, the potential use of these drugs is based on theoretical considerations that have resulted from an increased understanding of the processes both underlying and resulting from heart failure. Additionally, gene therapy that is targeted toward certain genes thought to contribute to heart failure is being tested.
These developments have justified an unprecedented optimism in the treatment of
congestive heart failure. The majority of patients, with appropriate lifestyle measures and medical regimens, can maintain active, fulfilling lifestyles. The range of treatment options has been significantly strengthened by drugs such as the ACE inhibitors and beta-blockers.
In the future, we will surely see the addition of many more and equally potent interventions.
- Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs.
- Many disease processes can impair the pumping efficiency of the heart to cause
congestive heart failure.
- The symptoms of congestive heart failure vary, but can include fatigue, diminished exercise capacity, shortness of breath, and swelling.
- The diagnosis of congestive heart failure is based on knowledge of the patient's medical history, a careful physical examination, and selected laboratory tests.
- The treatment of congestive heart failure can include lifestyle modifications, addressing potentially reversible factors, medications, heart transplant, and mechanical therapies.
- The course of congestive heart failure in any given patient is extremely variable.
REFERENCES:
Larson LW, Gerbert DA, Herman LM, Leger MM, McNellis R, O'Donoghue DL, Ulshafer C, Van Dyke EM; American College of Cardiology; American Heart Association. ACC/AHA 2005 guideline update: chronic heart failure in the adult.
JAAPA. 2006 Apr;19(4):53-6.
Heart Failure Society Of America. Evaluation and management of patients with acute decompensated heart failure.
J Card Fail. 2006 Feb;12(1):e86-e103. Review.
Amsterdam EA.
Revised American College of Cardiology/American Heart Association guidelines for the management of heart failure.
Prev Cardiol. 2005 Fall;8(4):254, 256.
Last Editorial Review: 6/23/2008
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