Heart failure is where the heart cannot pump the right amount of blood to meet the body’s requirement. Heart failure affects one or both sides of the heart. The causes of heart failure could be coronary artery disease, high blood pressure, and diabetes. There is not a cure out there that can get rid of this disease; however, there are several ways to manage it. Someone with this disease can take medication, use devices, or by surgical means. The research on the topics discussed in this paper is not conflicting because the data and trials talk about a specific device or a type of heart failure. There are clinical trials and research has been done to support this information. Heart failure is an interesting topic due to the fact it is increasingly becoming a prevalent disease throughout the United States.
This topic is interesting because someone close to me has died from it. Over the last couple of years, new research has come forward on ways to treat this disease and clinical trials to enhance the care of the patients. I believe there have been a lot of advances regarding heart failure. However, I think that people over a certain age should at least get tested once a year. These people need to be tested once a year because the earlier Heart Failure is diagnosed the faster the medical professionals can slow down the progression of this deadly disease.
Physiologically, heart failure is described in many ways. One description of heart failure is the following: ‘a myocardial disease caused by an injury to the heart followed by pathological ventricular remodeling’ (Krum). Myocardial is the muscular tissue of the heart. Heart failure is usually caused by a structural problem in the heart. There is always a primary incident that causes damage to the heart, which triggers this chain reaction. It can happen in many ways; for example, a heart attack, high blood pressure, coronary artery disease, or diabetes (Krum). People that have heart failure need to make changes in their life. These changes are: to exercise every day, reduce sodium intake, eat healthier foods, quit smoking and recreational drug use, and significantly reduce the intake of alcohol. Thus, it will slow down the progression of heart failure as much as it can. Heart failure entails four stages. These stages are labeled A to D.
Heart failure is diagnosed by a grouping of symptoms along with some medical tests. The doctor/cardiologist will be looking for certain things; for example, a third heart beat (besides the usual ‘lub’ ‘dub’), sinus tachycardia, basal pulmonary crackles, and so on. Some medical tests are the following: Electrocardiograms, Echocardiography, and MRIs. An electrocardiogram is a machine that displays a person’s heartbeat. Electrocardiograms are helpful because it can rule out a certain type of heart failure. Echocardiography uses ultrasound technology to examine the heart. This test can help with the diagnosis of heart failure because it can give the medical professional information about the left ventricle. MRIs or Magnetic Resonance Imaging is good to help determine if someone has heart failure because it gives a good evaluation of the ventricular structure and function. Also, the image the MRI gives is really detailed.
Stage D Heart Failure consists of patients with Heart Failure that is unmanageable regardless of the usual medical therapy and includes patients with recurrent trips to the hospital. Around 5% of patients with Heart Failure have Stage D (Dunlay). The risk of death in Stage D Heart Failure differs with every person because different symptoms are displayed. In the first year, it is estimated death is 28% and at the five-year mark is 80% (Dunlay). There are various forms of therapy for patients with Stage D Heart Failure. However, not all options are right for all patients, and some therapies may not be in alignment with Stage D heart patient goals.
An effective therapy is Mechanical Circulatory Support; however, only for specific patients with stage D Heart Failure. This is because every form of treatment is different for everyone. Mechanical Circulatory Support is a device such as a pump that aids the people with Heart Failure (Dunlay). A heart transplant is a great option; however, the amount of hearts is not that many, having remained around 2,200 heart transplants a year in America with most organs given to younger stage D heart failure patients with limited existing medical conditions (Dunlay). Mechanical Circulatory Support device size is smaller than it used to be and the number of complications has gone down. Another type of mechanical circulatory support is left ventricular assist devices. These devices help with the blood flow from the left ventricle through the pump into the aorta. An aorta is a major systematic artery that receives blood from the left ventricle (Mader). They are long-lasting and have permitted patients who do not qualify as a candidate for a heart transplant, life to be a little easier.
Along with every form of treatment, there are dangers and advantages with mechanical circulatory support. Continued existence and value of life have gotten better in patients with Stage D Heart Failure treated with mechanical circulatory support equated with medical therapy. Sixty-eight percent continue to live for one-year with mechanical circulatory support and twenty-five percent with medical therapy (Dunlay). Both left ventricular assist devices and medical therapy have the same complications, which includes device-related infection and stroke. When someone goes to the hospital after left ventricular assist device being implanted, it is because of gastrointestinal bleeding. If we separate, the term gastrointestinal, it means ‘stomach’ and ‘intestines.’ Only about 30% of patients receiving mechanical circulatory support do not get an infection, bleeding, device malfunction, stroke, or death within the first year (Dunlay). Most patients need one or more hospitalizations early after implantation, with an average of two hospitalizations in the first six months (Dunlay). A checkup on a person’s left ventricular assist device is an important part of the long-term care of the left ventricular assist device. This checkup is done by a machine.
Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial also known as REMATCH was conducted regarding certain mechanical circulatory support (Salters). This trial assessed the continued life expectancy in Heart Failure patients utilizing a pulsatile flow left ventricular assist device. The researcher’s results stated that living a complete year with a left ventricular assist device was 52% compared with the 25% in the optimal medical therapy group (Salters). At the two-year mark, the 23% of the group people still living with left ventricular assist device (Salters). Continuous-flow Left Ventricular Assist Devices have been made obtainable and are considered better than pulsatile-flow Left Ventricular Assist Device Support. When the researchers were investigating information regarding patients who are ineligible for a heart transplant, they found out 58% of people still living two years after implantation of their continuous-flow Left Ventricular Assist Devices. The researchers found that 24% with the pulsatile flow Left Ventricular Assist Device were still living after two years (Salters). Also, the rate of major difficult events lessened and reoccurring trips to the hospital with the continuous-flow Left Ventricular Assist Device. Left ventricular assist devices are still an option specifically for patients in which death is going to happen soon rather than later without more therapy.
Mechanical circulatory support technology continues to make adjustments. The company CircuLite Synergy is developing an implantable miniature pump. This device gives a chance to provide long-term partial maintenance but have the benefit of not requiring a sternotomy to implant this pump. Thoratec Corporation created HeartMate III. The design is compact but still gives full support to people with this particular device. Biventricular support is currently providing some with the total artificial heart, a pump that is implanted with a removal of both native ventricles and most of both atria. SynCardia Systems, Inc., created the Total Artificial Heart, which has been approved by the Food and Drug Administration since 2001(Dunlay). The information that has come forward about continuous flow pumps in both ventricles has been good.
People diagnosed with Stage D Heart Failure need to start the process of advance care planning. This stage consists of numerous trips to the hospital and cumulative resource use in patients with Heart Failure occurs at the end of life. The Seattle Heart Failure Model is the most widely used to predict death and hospitalizations (Dunlay). However, the models are not always correct in guessing the end results. On the other hand, they are generally more correct than clinical judgment. Combining risk prediction models with adaptive based on clinical knowledge of an individual’s situation could be the best method to get an accurate customized risk prediction (Dunlay). Another element of advance care is advance directives.
It is important for physicians to check patients’ preferences sporadically for care in the case of expected and unexpected events. Advance directives are an important part of advance care planning and documentation of the way they want to be cared for, are completed in 41% of patients (Dunlay). Planning and documentation need to be completed and edited as needed after discussion among patients, physicians, and families. Palliative care an option is to improve the value of life and support patients and families as they deal with chronic and complex illnesses is linked to improved patient and family satisfaction and decreased health care utilization and costs should be considered as an option in patients with Stage D Heart Failure (Dunlay). Palliative medicine can help with planning prior to the application of advanced therapies such as left ventricular assist device and transplant.
The absolute last option of treatment for people with heart failure, who still continue to be displaying symptoms regardless of the correct amount of medical management, is a heart transplant. To figure out that a heart transplant is the best option, indications include the following: refractory (unmanageable) cardiogenic shock, reliance on nonstop intravenous inotropic support in high doses to maintain adequate organ perfusion, ruthless symptoms of ischemia not susceptible to coronary angioplasty, or instability of fluid balance/renal function that has nothing to do with patient not complying (Salters). Heart transplantations happen around 2,500 times every year (Salters). Therefore, cardiologists and everyone’s efforts are made to handle patients with medications, devices such as mechanical circulatory support and surgical approaches prior to pursuing the last resort of heart transplantation. A lot of the situations dealing with heart transplants are present because it is unsafe to the patient. It could unsafe because of the following reasons: over 70 years old, irreversible pulmonary hypertension, severe pulmonary disease, severe peripheral vascular disease, irreversible renal or hepatic dysfunction, diabetes with end-organ damage, obesity, severe osteoporosis, and current alcohol or drug abuse.
Stage D heart failure is the last stage of heart failure and has reached the point where it is unmanageable. Stage D is otherwise known as refractory. A person that has this stage of heart failure needs to get their affairs in order. Mechanical Circulatory Support has made many advances. This form of support has offered some patients with end-stage Heart Failure new life-prolonging options. The trials that have been discussed had similar results. The trial and death were about similar aspects of Stage D Heart Failure and Mechanical circulatory support. The results were different numbers; however, they were very close to each other. Also, the number of heart transplants was different, but only by three hundred people. This result was most likely based on the time the research was conducted.
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