Overview: Heart Failure

• Much has changed within a relatively short time span with respect to the management of chronic heart failure. Sadly, much remains largely unchanged.

• Pharmacologic and technologic advances for the treatment of heart failure helped set the stage stage for updated treatment guidelines developed jointly by the American Heart Association (AHA) and the American College of Cardiology (ACC) in 2005.

• The guide lines have undergone gentle refinements since then, and the results of more recent investigations offer great promise for people with chronic heart failure.

• The reality, how ever, is that morbidity, mortality, and the escalating financial burden to society associated with heart failure remain main unacceptably high.

• The T statistics are sobering. At the 40 years of age, the lifetime risk of developing heart failure for both and women is 20%. Almost 6 million US residents (2.6% of the population) are believed to have had heart failure in 2006, with an incidence approaching 10 per 1000 population after age 65 years.

• Heart failure is the most frequent Medicare diagnosis-related group, and a conservative estimate of the direct and indirect cost of heart failure re in in the United United States for 2010 1 539.2 billion.

• The year mortality rate for heart failure is high, I in 5 will die, and in 2006, 1.in 85 death certificates (282,754 deaths) in the United States mentioned heart failure.

• Most cardiologists and epidemic ologists believe that the incidence of left ventricular systolic dysfunction will continue to grow as the population ages and as more people survive heart attacks.

• These same as more people survive hear experts believe that the statistics show that the attention and energy applied by the health care system to the war on heart failure should be equal to those applied to the war on cancer

• Few, if any, medical problems so burden our health care system as heart failure and offer a picture of both the need and potential benefit of an integrative approach to care.

• The single best way to treat heart failure is to prevent development, because once established, heart failure follows an inexorable progression toward greater infirmity and death within a few years.

• Prevention, prevention, prevention must be our mantra with respect to heart failure management Lifestyle and dietary measures that promote heart health should be established early in life, and improved access to preventive medical care across socioeconomic strata should be mandated.

• Careful surveillance for early signs of hypertension, diabetes, obesity, and coronary artery disease is essential, as well as aggressive treatment of these same maladies, with means both safe and effective drawn from the spectrum of available interventions.

Important points to consider

• Integrative treatment of heart failure focuses primarily on prevention.

• Hawthorn, a long favored herbal remedy for mild forms of chronic heart failure, possesses actions largely supplanted by conventional medications and in one study was associated with untoward risk.

• Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and aldosterone antagonists all have a positive impact on mortality related to heart failure.

• The most significant recent change in the conventional medical treatment of chronic heart failure is the increased reliance on device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillators).

Prevention Prescription

• Do not smoke. If you do smoke, get help to quit.

• Follow an anti-inflammatory or Mediterranean-style diet.

• Participate in regular physical fitness activities.

• Manage stress in healthy ways.

• Maintain a healthy weight for height.

• Work with your doctor to manage medical conditions that may lead to heart failure, especially high blood pressure, coronary artery disease, high cholesterol levels, and diabetes.

• Speak with your doctor about ways to prevent and if necessary, treat depression.

• Attend to your spiritual side.

• Have the pneumococcal vaccination and your annual flu vaccination.

• Avoid overuse of nonsteroidal anti-inflammatory medications (NSAIDs).

Integrative therapeutics review

All patients with heart failure should be started on some combination of angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), or beta blocker, and aggressive management of comorbidity should be undertaken.

Removal of Potential Exacerbating Factors

• Try to discontinue nonsteroidal anti-inflammatory drugs and first-generation calcium channel blockers.

Stress Management and Mind-Body Therapy

• Promote proper attention to mood and stress management, and offer instruction in and access to tools such as meditation, refixation response, and tat chi

Graded Exercise

• Enroll patients in a certified cardiac rehabilitation program

Nutrition

• Encourage an anti-inflammatory het or Mediterranean style diet.

• Urge fluid and salt restriction.

Spirituality

• Inquire about and address needs in an open fashion, and use pastoral care services as appropriate

Bioenergetics

• Acupuncture

Supplements

• Coenzyme Q10: 100 to 200 mg daily

• Propionyl-carnitine: 1 to 3 daily

• Arginine 2-6 g three times daily

Botanicals

• Hawthorn 600 to 1800 mg daily (exercise caution when using with digoxin)

Pharmaceuticals

• ACE inhibitors

• ARM

• Beta blockers

• Aldosterone antagonistic

• Isosorbide dinitrate in combination with hydralazine

• Diuretics

• Digitalis

Surgery

• Cardiac resynchronization therapy or implantable cardioverter defibrillator

• Left ventricular assist device

• Cardiomyviplasty

• Inotropic infusion

• Heart transplantation

• Stem or progenitor cell transplantation

Key Web Sources

• http://www.heart.org/HEARTORG/Conditions/Heart Failure/Heart-Failure_UCM_002019_SubHomePage.jsp.

• http://www.heartfailureguide-line.org/

• http://www.guide-line.gov/content.aspx?id=10587

• http://naturaldata-base.therapeuticresearch.com/home.aspx?cs=&s=ND