Heart-Failure Treatment by Device
Technological breakthroughs are changing the course of heart-failure treatment -- but doubts remain about how many people will benefit in the near future.
Cardiac Resynchronization Therapy (CRT)
Cardiac resynchronization therapy is a new and promising treatment. "Resynchronization therapy is the biggest story in device therapy for heart failure," says Konstam, who is also president of the Heart Failure Society of America.
In some patients with heart failure, the electrical signals that coordinate pumping of the different heart chambers become erratic, making the heart unable to pump blood efficiently. In addition, an already weakened heart wastes energy by fighting against itself.
CRT devices deliver electrical impulses to both the right and left ventricles -- the two large, main pumping chambers of the heart -- restoring the coordination between the two sides of the heart and improving its function.
Michael R. Bristow, MD, PhD, of the University of Colorado Health Sciences Center in Denver, was involved in one of the biggest studies of CRT ever done. Results were published in the May 2004 issue of The New England Journal of Medicine. Participants, all who had advanced heart failure, were divided into three groups: The first group got the best drug treatment -- a beta-blocker, an ACE inhibitor, and a diuretic -- while the second and third groups got the drug treatment plus either a CRT device or a CRT device with a defibrillator (the two devices now come together in one device). Researchers found that compared with aggressive medication treatment alone, adding CRT to treatment reduced the risk of death by 24%. Combining CRT with a defibrillator (the two devices now come together in one device) reduced deaths by 36%.
"CRT makes you feel better, keeps you out of the hospital, and gives you a better quality of life," Bristow tells WebMD.
Left Ventricular Assist Devices (LVADs)
In the past, people with end-stage heart failure had to rely on the hope of a transplant. Left ventricular assist devices (LVADs) were originally designed as "bridge" therapy, to help people with a weak left ventricle -- the main pumping heart pumping chamber -- survive while they waited for a heart transplant.
LVADs are implanted, pump-like devices that assist the weakened heart in circulating blood. While LVADs were originally attached to large control panels in hospitals, newer devices are smaller and contained, allowing patients to leave the hospital and go home with a small external device and battery pack. LVADs are generally used in people who are not eligible for heart transplants, usually because of age.
While transplants are a highly effective heart-failure treatment, the chances of getting one are limited by the availability of donors. Only about 2,500 people in the U.S. receive a heart transplant each year while many more remain on waiting lists; heart failure causes 50,000 deaths annually and contributes to another 250,000 deaths. A mechanical device like an LVAD that doesn't rely on donors could make a huge difference in heart-failure treatment.