Take Heart: Restoring Quality of Life for Patients with Advanced Cardiac Disease
By John Herre, M.D.
Our community recently marked a significant milestone – the 20th anniversary of the Sentara Heart Transplant Program. To help celebrate, the hospital gathered many physicians, hospital staff and patients and families of the program. We were able to see the programs success in the form of so many patients living today with donated hearts and advanced medical care. Our second recipient received his heart 20 years ago and continues to live a full life at age 79 thanks to a generous donor family.
According to the American Heart Association, an estimated 5 million Americans have congestive heart failure and 250,000 people in the U.S. die from it a year. More than a half a million new cases are diagnosed each year. The five-year average mortality rate is 50%. These numbers are expected to increase rapidly as our population ages.
Despite modern advances in medicine and surgery, the need for organ donation is not going away. In fact, we at Sentara follow more patients today than at any other time and we will perform more advanced heart failure procedures in 2009 than in any year in the history of the program. Heart transplantation remains the best treatment for end-stage heart failure but only about 2000 patients across the country receive heart transplants each year. This number will increase only with continued efforts to increase awareness about donation. More than 3000 patients are currently on the waiting list with more patients being added to the list all the time. The waiting time is growing and many patients will not survive to transplant
As demand for heart transplantation surpasses the availability of donor hearts, physicians around the country have turned to technology to treat more patients. Ventricular assist devices (VADs) have emerged as an alternative form of treatment for such patients. VADs can assume most of the pumping function of a weak heart. In the past, these pumps have been used only for end stage heart failure patients as a bridge to recovery after heart surgery, or as a bridge to transplant while they are wait-listed for a suitable donor heart. Increasingly, we are beginning to see the use of VADs as a permanent or “destination” therapy for patients.
Sentara recently participated in the multicenter HeartMate II Destination Therapy Trial which compared a newer, smaller and more efficient pump with older technology. The results of the study showed that after two years, 46 percent of patients on the new pump and 11 percent of those on the older pump were alive, without device failure or strokes. At our own institution, 19 or the 21 patients who have received the HeartMate II remain alive with the pump or having received a transplant after prolonged support with the pump.
With destination VAD implantation, many patients who are too old or who have other, serious medical problems which might prevent a heart transplant benefit from a longer, better quality of life. The device enables most to live independently, away from a hospital bed. Without the device, their health continues to worsen, with many expensive readmissions back to the hospital.
But with implantation of destination therapy devices, instead of staying in the hospital waiting for a heart, they can be discharged home with the devices implanted and live relatively normal lives.
As a physician, my commitment is to continue to look for the best and greatest number of options for patients with heart failure. My hope is that future anniversary celebrations will feature more transplants through more organ donation, better technology to help patients and even more patients with success stories to tell.
John Herre, M.D., is a cardiologist practicing in Norfolk. He serves as the Scientific Director of the Sentara Cardiovascular Research Institute and Director of the Sentara Advanced Heart Failure Program.