Cardiologists say a dramatic change is needed in treating some heart patients

Nov 8 2006

According to researchers at Johns Hopkins University in the U.S. a dramatic change is needed in the way hundreds of thousands of Americans with a form of heart failure should be treated.

The cardiologists say they have found evidence that patients with non-systolic heart failure may benefit more from pacemakers to speed up the heartbeat than from continual, long-term use of beta blockers, drugs that actually slow down the heartbeat.

Figures suggest that almost half of the 550,000 Americans newly diagnosed each year with heart failure, have the non-systolic form.

Senior study investigator David Kass, M.D., a professor at the Johns Hopkins University School of Medicine and its Heart Institute, says cardiologists are being forced to rethink heart failure because one size does not fit all and care is needed in diagnosing and approaching its treatment.

Professor Kass also says that greater numbers of older adults who have heart failure, mostly women over age 50, have hearts which appear to pump normally and all facets and manifestations of the disease must be understood.

Such cases says Kass are clearly different from traditional, systolic heart failure, where pumping function is depressed but almost all of the research over the last three decades has applied only to those with systolic heart failure.

Non-systolic heart failure is characterized by fairly normal function of the heart’s pumping action, or so-called ejection fraction, when a person is at rest.

This action falters, however, once daily physical activity begins, and the heart becomes increasingly unable to squeeze out sufficient blood flow to energy-starved muscles.

Even small tasks, such as getting dressed in the morning, can leave people exhausted and short of breath.

Kass says until now researchers had thought the problem was that these hearts could simply not relax properly, a so-called failure of their diastolic function.

The Hopkins team plans to launch within the next year a national study of the use of pacemakers in patients with this form of the disorder, which is sometimes referred to as heart failure with preserved ejection fraction or heart failure with normal ejection fraction.

In some cases, a combination of drug and pacemaker may work best to control the disease, speeding up the heartbeat at times, slowing it down at other times.

The scientists will monitor more than 80 men and women with mild to moderate, non-systolic heart failure; half will be prescribed traditional beta blocker medications, the most commonly prescribed treatment, while the rest will not.

All will be implanted with a pacemaker and perform exercise tests to see if their symptoms get better or are possibly even reversed.

If the new study validates their preliminary work, Kass predicts that his research could change the practice guidelines about how beta blockers and pacemakers are used in this form of heart failure.

The American Heart Association estimates that more than 5 million Americans have some from of congestive heart failure, marked by symptoms such as shortness of breath and fatigue.

The report from the Hopkins team is published in the journal Circulation.