Jewish World Review Oct. 31, 2002 / 25 Mar-Cheshvan, 5763

Survival after heart failure has improved

By Steve Mitchell | (UPI) A federal government study released Wednesday finds the risk of dying from heart failure has declined significantly in both men and women over the past 50 years.

Death rates declined by about a third in men and women who had been diagnosed with heart failure, lead author Daniel Levy, of the National Heart, Lung, and Blood Institute in Bethesda, Md., told United Press International.

The researchers analyzed data from more than 1,000 men and women participating in the Framingharm Heart Study who developed heart failure from 1950 to 1999. Heart failure is defined as the heart's inability to pump adequate amounts of blood and nearly 5 million Americans suffer from the condition, which is usually the end result of years of heart disease or high blood pressure.

In the first nine years -- 1950-69 -- 70 percent of men died within five years of being diagnosed with heart failure. This rate dropped to 59 percent between 1990 and 1999, Levy's group reports in Thursday's edition of The New England Journal of Medicine.

From 1950 to 1969, 57 percent of women died within five years of being diagnosed with heart failure. That rate dropped to 45 percent in the 1990s.

The decline in mortality probably is due to the development of more effective drugs and treatments for heart failure, Levy said. Newer drugs, such as ACE inhibitors and beta-blockers, have been shown in clinical trials to reduce mortality and "this would be consistent with declines in mortality in heart failure patients" seen in this study, he said.

He noted, however, "Heart failure is an enormous public health problem and it remains one of the most common causes for hospitalization in the elderly."

More than half of those who develop heart failure will not survive for longer than five years, he said. "It remains highly, highly lethal," he added.

New cases of heart failure declined by a third in women during the study period but there was no change in men. The incidence of disease probably is declining in women and not in men because of risk factor differences, Levy said.

High blood pressure is more closely linked with the development of heart failure in women and awareness, treatment and control of the disease has improved.

In men, heart attacks are more closely tied to heart failure. There have been improvements in treating the condition but this may contribute to an increasing number of heart failure cases, Levy said.

Better heart attack treatments are "allowing men to survive who now have damaged hearts and are at an increased risk of developing heart failure," he said.

Margaret Redfield, director of the Mayo Clinic Heart Failure Clinic in Rochester, Minn., who wrote an accompanying editorial, agreed better treatments may be increasing the number of people susceptible to heart disease.

"There will be dramatically more people developing heart failure," she told UPI.

Redfield noted the major decline in the incidence of new cases occurred in the 1970s and the rate has remained stable since then. That, coupled with the increase in the number of elderly people -- 85 percent of heart failure patients are over age 65 -- means the number of people developing heart failure will increase, she said.

Levy, however, said heart failure is viewed as a preventable disease. Treatment of high blood pressure in the elderly, for example, can reduce the risk of heart failure by half, but yet only about 27 percent of those with high blood pressure actually are being treated for it.

Redfield agreed treatments for these heart failure risk factors can help but it means "more people are alive to ultimately develop heart failure."

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© 2002, United Press International