Co-Author: Michael W. Hartley, M.H.A.
Congestive Heart failure (CHF) is the most common reason for hospitalization among those over the age of 65 years. In fact, both the incidence and prevalence of heart failure increases dramatically in the elderly population, while survival from ischemic heart disease has improved with new treatment modalities. Symptoms of heart failure can be disabling, affecting simple activities of daily living. Despite advances in medical treatments, including ACE Inhibitors, Beta-Blockers and Aldosterone Antagonists, which have improved the outlook for most patients, many remain very symptomatic. Morbidity and mortality rates for CHF patients are still high, creating a need for improved therapies. Recent clinical trials have established an adjunctive and important role for Device Based Treatment consisting of implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapies (CRTs), separately and combined. The intersection of medical and device therapy for heart failure now offers the greatest opportunity to change the natural history of those patients affected with symptomatic left-ventricular dysfunction. Dyssynchrony is an inefficient means of ventricular contraction that is indicative of conduction-system disease and is usually associated with prolonged QRS duration on the 12-lead ECG. In these patients, CRT has consistently resulted in improved functional class, quality of life scores and hospitalization in several randomized trials. Implantable cardiac defibrillators have been shown to reduce mortality in patients at high risk for arrhythmia and sudden death. Research has shown ICDs more often prevented death in certain types of patients, including those “with previous cardiac arrest, patients with symptoms from abnormally fast beats of the ventricles, and some patients with decreased heart muscle strength from coronary artery disease or heart attack.”1 Given ideal application of medical and device therapies to patients with heart failure and impaired ejection fraction, the risk of death from heart failure can be substantially reduced, perhaps by 50% or more. At the West Palm Beach VA Medical Center, we have to date utilized such therapy (combined CRT/ICD) in approximately 500 patients. There has been a close coordination of care between primary care physicians, hospitalists, cardiologists, and electrophysiologists, thus helping select veteran patients diagnosed with CHF receive the highest quality of care in a timely manner.
