BEST TREATMENTS: MANAGING HEART FAILURE

One day stem cells may be used to repair damaged heart muscle, but people with heart failure can't wait years for this research to pan out. Fortunately, many effective treatments for heart failure have emerged in recent years--so the big challenge for doctors and patients is to be sure that nothing is overlooked. Here is a quick checklist.

Get an echocardiogram. Heart failure can be caused either by weakness or by stiffness of the heart's main pumping chamber, the left ventricle. The symptoms are similar, but the treatments differ. An echocardiogram can sort this out.

If you have heart failure due to a weakened left ventricle, you should be on a vasodilator--a drug that opens blood vessels--to decrease the workload of the heart. Angiotensin-converting-enzyme (ACE) inhibitors like lisinopril or ramipril lower blood pressure, reduce the risk of premature death by 15 to 20 percent and improve quality of life. So does a new class of drugs called angiotensin-receptor blockers. African-Americans seem to benefit less than Caucasians from ACE inhibitors, but respond better to a combination of two older drugs--hydralazine and nitroglycerin--that are now being marketed as a single pill under the name BiDil.

Research has shown that beta blockers like carvedilol, bisoprolol and sustained-release metoprolol lower mortality by 30 percent or more. They work by protecting the cardiovascular system from the damaging effects of adrenaline circulating in the blood. They are among the most underused life-saving drugs in medicine--only about 60 percent of patients with heart failure take them.

If you still have symptoms, have you tried digoxin or diuretics? Digoxin makes the heart beat slightly stronger, and diuretics help the kidneys get rid of extra water. Because these drugs don't increase survival, they are usually used when patients still have symptoms like shortness of breath despite use of vasodilators and beta blockers.

For severe heart failure, try an aldosterone antagonist. An old drug called spironolactone and a newer one called eplerenone can lower mortality for patients with severe heart failure, but they can also cause dangerous elevations in potassium levels. These drugs are currently recommended just for people whose heart failure limits them to minimal activity.

Some people with heart failure have damaged electrical systems that cause the two sides of their hearts to beat out of rhythm. That loss of coordination decreases the amount of blood pumped out of the heart with each contraction. Special pacemakers can "resynchronize" the heart's lower chambers, reduce symptoms and prolong survival.

The more severe the damage to your left ventricle, the greater your risk of sudden death from heart-rhythm abnormalities. An implant-able cardioverter defibrillator (ICD) can often "shock" a dying heart back into a normal rhythm. The people most likely to benefit from these expensive devices are those whose left ventricles can eject less than 30 percent of their contents with each heartbeat.

Programs that help people with heart failure exercise, monitor their weight and symptoms, and adjust their drugs between doctor visits are an increasing part of disease management. These programs help people live longer, feel better--and save money by reducing hospitalizations.

In the past 20 years, novel treatments have given people with heart failure a new lease on life. Yet not every patient who could benefit is taking the latest treatments. If you or a loved one has heart failure, you should talk to your doctor and know about your options.