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The Heart and Heart Failure in the Year 2013Jonathan D. Rich, MDAssociate Director, Mechanical Circulatory Support ProgramBluhm Cardiovascular InstituteAssistant Professor of MedicineNorthwestern University Feinberg School of MedicineOutlineBasics of the heart and the cardiovascular system

Define the term heart disease

Heart disease risk factors and prevention

Heart Failure as a major consequence of heart disease

Treatment of heart failure in 2013

Q and ASince 1900, heart disease has been the No. 1 killer in the United States every year but 1918Nearly 2,600 Americans die of heart disease each day, an average of 1 death every 33 secondsAlmost 150,000 Americans killed by heart disease each year are under age 65Bet you didn't know....3Influenza in 1918. Big problem. Not only disease of the elderly.The Heart BasicsA muscle about the size of your fist

Weighs approximately one pound

Is located behind and slightly to the left of the breastbone

Pumps about 5 liters of blood every minute

Major Function of the HeartPump blood through the lungs to refresh the blood with oxygen and remove carbon dioxideThe oxygenated blood is pumped to the body to provide oxygen and nutrients and to remove waste productsThe coronary arteries are the blood vessels that supply blood and oxygen to the heart

What exactly is heart disease?Any disease that affects the heart

Because coronary artery disease is so common, many people use the term heart disease synonymously with coronary artery diseaseCoronary Artery Disease

Coronary artery disease is one of the most common causes of heart disease. Fatty deposits build up in blood vessel walls causing narrowings, called atherosclerosis. Over time, this can lead to a complete blockage of the coronary artery and a heart attack.

High cholesterolHigh blood pressureDiabetes SmokingObesityLack of physical activityGenetics

Heart Disease Risk FactorsChoose your parents wisely!Choose your parents wisely!

10Heart Disease Risk FactorsUncontrollable

SexRaceAgeGenetics

Heart Disease Risk FactorsUncontrollable

SexRaceAgeGenetics

ControllableHigh cholesterol High blood pressureDiabetes SmokingPhysical activityObesityStress and angerPreventionGet regular medical checkups.Control your blood pressure.Check your cholesterol.Dont smoke.Maintain a healthy weightAvoid diabetesExercise regularly.Manage stress.Choose your parents wisely!

Heart Failure: Incidence and PrevalenceApproximately 5,000,000 Americans currently suffer from heart failureApproximately 500,000 new cases of heart failure are diagnosed each yearAmong those with heart failure, approximately 250,000 have advanced or Stage D heart failure Nearly 1,000,000 hospital discharges per year for heart failure and the most frequent cause of hospitalization in the elderlyGiven the burden of heart failure, emphasis on aggressive, guidelines-based medical heart failure therapy is critical.

1 World Health Statistics, World Health Organization, 1995.2 American Heart Association, 2002 Heart and Stroke Statistical Update.Heart failure is estimated to afflict more than 22 million people worldwide with an estimated 2 million new cases diagnosed annually.1In the United States it is estimated that 5 million people have HF, with 10 out of every 1,000 over the age of 65 being afflicted.2It is the only major cardiovascular disorder that is increasing in incidence and prevalence.Other Heart Failure Statistics:HF patients take an average of six medications378% of HF patients have had at least two hospital admissions per year3 Cost of HF in the U.S. is estimated to be between $10 billion and $38 billion annually4 5-year survival rate for all NYHA classes estimated at 50%2

1 World Health Statistics, World Health Organization, 1995.2 American Heart Association, 2002 Heart and Stroke Statistical Update3 English M and Mastream M. Crit Care Nurse Q 1995;18:1-6.4 Havranek EP, Abraham WT, The Healthcare Economics of Heart Failure 1998; 14:10-18.

14Heart FailureWhat is Heart Failure?A. The heart is not pumping/squeezing as well as it should (aka systolic heart failure)B. The heart is not relaxing as well as it should (aka diastolic heart failure)Usually, the heart has been weakened by an underlying condition(s)Blocked coronary arteries/heart attackHigh blood pressure Heart valve abnormalitiesViral infectionOther/unknownHeart FailureHeart failure can involve the left or right side of the heart (or both sides)

In the majority of cases, the left side is affected first

Heart failure occurs when either side of the heart cannot keep up with the demands placed on it to provide sufficient blood flow to the bodyHeart FailureHow quickly does heart failure develop?It dependsOften a chronic disease with a slow, insidious onsetOther times can develop rapidly (i.e. after a large heart attack or an acute viral infection).The heart tries to compensate for the loss in pumping function by:Developing more muscle massEnlarging itselfPumping faster

17Whereas a heart attack can kill you instantly, heart failure is usually slow and progressive.Natural History of HFSurvival (%) LV Dysfunction and SymptomsMechanism of DeathSudden death40%Worsened HF40%Other20%ProgressionAnnual Mortality0%100%AsymptomaticMildModerateSevere