Published In August 7th, 1998 In The Centers For Disease Control's Morbidity And Mortality Weekly Report
A study in Morbidity and Mortality Weekly Report reports a decline in deaths from congestive heart failure (CHF) for people 65 years of age and older between 1988 and 1995. The drop was greatest for black adults - 3 percent per year for black men and 2.2 percent per year for black women. However, CHF, affecting 4.9 million, is the leading cause of admission to hospitals.
David A. Meyerson, M.D., an American Heart Association spokesperson and cardiologist at Johns Hopkins University in Baltimore, said he was "delighted, but not surprised" by the CDC report. "The report suggests that strategies advocated by the American Heart Association are responsible for the decline in mortality from CHF.
"We are on the right track - we have more strategies than ever before to help people live better, more active and productive lives with CHF and we are well-positioned to prevent CHF failure if higher-risk patients follow doctor's advice and remain compliant with their medicines."
Strategies include: 1. Earlier identification and better treatment for those at high risk, especially those with high blood pressure; 2. Better initial treatment in the first few hours after a heart attack to minimize loss of heart muscle; 3. Better treatment within the first few days after a heart attack to allow the damaged heart to remodel (heal) more appropriately; and 4. Better medications and improved medical follow up for those who already have CHF. Increased survival is enhanced because of better medical treatments, such as broader use of angiotensin converting enzyme inhibitors (ACE inhibitors), which are of particular value in the early phases after heart attacks to prevent development of CHF. For those who already have CHF, these medicines can often improve exercise capacity.
Since the mid-1980s, patients treated in community settings have had greater access to sophisticated treatments for heart attacks, a cause of CHF. For example, by the mid-to-late 1980s, "clot-busters" were in wide use and these agents have increased survival.
"However, 'clot-busters' work well in only 75 percent of patients, and some seek medical attention too late for 'clot busters' to be of value. Many heart attack survivors still develop CHF, which, in part, accounts for the growing number of people living with disease," said Meyerson.
"The increase in people living with CHF is partially caused by American medicine doing its job well, saving people who would otherwise have died, but leaving them with some degree of CHF. In this situation, treating chronic CHF is the better of the two alternatives," he added.
"The greater availability of treatments has probably helped to push the death rate for African-Americans lower," noted Meyerson. This group appears at especially high risk for the ravages of high blood pressure, including CHF, heart attack and stroke.
"In addition, educational campaigns aimed at building awareness about treating high blood pressure, as well as having better types of medications to chose from, with fewer side effects, have probably helped more people remain compliant with high blood pressure medications," he said.
Congestive heart failure is a condition that occurs because the heart muscle is damaged or overworked, and the heart doesn't pump as efficiently as before. This damage can result from high blood pressure, a heart attack, atherosclerosis (hardening of the arteries), congenital heart defect or valvular heart disease, alcohol abuse and certain viral infections that may affect the heart.
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