Heart Failure

Research Topics Source: American Heart Association

Animals in Research
The American Heart Association supports using animals in biomedical research, because it helps us improve heart health and save lives. In fact, the decline in U.S. death rates from heart disease and stroke since the 1960s is due in part to discoveries from research using animals.
So, when animals are needed for experiments we fund, researchers must handle them responsibly and humanely.
Before receiving our funding, we require researchers to show that:

They have considered alternative methods to using animals.
Their research can’t be successfully done without using animals.
Their experiments are designed to produce needed results and information.

Cloning Research
The American Heart Association supports cloning research because it could lead to new procedures and techniques to reverse degenerative heart disease. For example, it may help generate new, healthy heart tissue, valves and other vital tissues and structures.

The cloning research we fund includes those involving human DNA sequences and cell lines and animals. We don’t support cloning to create human beings and cloning to create humans or embryos for research material.
They are strictly prohibited under our guidelines.

What is cloning, and how can it be used?
Natural sexual reproduction requires a sperm from a male and an egg from a female. These are fused at fertilization. The sperm and the egg each contribute half of the chromosomes needed to create a new individual.
The chromosomes are found in the fertilized cell's nucleus.

In cloning, a cell from the body of an adult donor (somatic cell) is put in a culture dish and grows. At a certain point, the growth of this cell is stopped. Then the somatic cell is electrically fused with an egg from which the nucleus has been removed. (Removing the nucleus means there are no chromosomes in the egg.)
The fused cells then begin to grow and divide in the culture dish. After several divisions, this early embryo is moved to the uterus of the surrogate mother and allowed to develop.
The somatic cell has all the chromosomes, so the embryo has the same genetic makeup as the somatic cell donor.

The scientific and medical value of cloning is that it can be used to produce "transgenic clones" or "transgenic species."
These terms mean that one species carries the genes of another species.
For example, transgenic clones of female cattle, sheep or goats can be genetically designed through cloning to be "dairy pharmaceutical producers."
For examples, they could produce:

Milk that has the human clotting factor IX to treat people with hemophilia
Milk with insulin to treat people with diabetes
Milk with interferon to treat people with viral infections
Other pharmaceutically useful milk products

Transgenic clones also can be used to:

Develop tissue to transplant into humans to treat diseases.
Perhaps develop organs for transplantation.
Genetically design animals that have certain human diseases and can be models to study and treat those diseases.
Preserve endangered species.

Gene Therapy
What is a gene?
A gene is a discrete sequence of DNA that contains information to make a protein. Sometimes a gene can be defective or missing.
A defective gene may cause a protein that doesn’t work correctly to be made.
A missing gene may mean essential proteins aren’t made.

What is gene therapy?
Gene therapy is correcting functional gene loss by delivering genes to human tissues or expression of a "therapeutic gene" in a target tissue.
Often, DNA viruses engineered to be safe or non-viral DNA help deliver a healthy gene to the tissue cells.
In general, non-viral vectors deliver genes to cardiovascular cells. Viruses are more efficient, but have a higher safety risk.

How is gene therapy used in treating cardiovascular disease?
To date, the earliest experiments seem promising for treating cardiovascular disease.
For example, researchers have used gene therapy to help increase blood flow to ischemic tissue. Ischemia is a condition in which the flow of blood, and thus oxygen, is restricted to a part of the body.
Limb ischemia and myocardial ischemia is lack of blood flow and oxygen to the limb and heart muscle, respectively.

The body’s first response to less blood flow to the heart is to grow tiny new “collateral” vessels to help blood flow around the blockage. (This process is known as angiogenesis.) For unknown reasons, the process eventually switches off.
Some proteins in the body can help trigger new blood vessel growth and increase the oxygen supply to the ischemic tissue.

In gene therapy trials, scientists have delivered genes into the hearts of patients with advanced myocardial ischemia in different ways. After gene therapy, patients had less severe angina (chest pain) and their hearts worked better.
Similarly, after delivery of certain genes to patients with limb ischemia, the blood supply improved and leg sores healed better.
Gene therapy has prevented below-knee amputation in some patients for whom amputation had been recommended.
Gene therapy has also prevented re-occlusion, or re-blockage, of coronary artery bypass grafts and kept arteries open after angioplasty surgery.
The outlook for gene therapy is promising, but it still needs many improvements before being a routine treatment for cardiovascular disease.

Stem Cell Research
The American Heart Association funds meritorious research involving human adult stem cells, because it helps us fight heart disease and stroke.
We don’t fund research involving stem cells derived from human embryos or fetal tissue.

What are stem cells, and how can they be used?
Stem cells are unspecialized cells within the body that can develop into one or many kinds of cells.
Stem cells potentially could treat or cure many diseases and conditions, including Parkinson's disease, Alzheimer's disease, Diabetes, Certain Heart Diseases, Stroke, Arthritis, Certain Birth Defects, Osteoporosis, Spinal Cord Injury, and Burns.

The two types of human stem cells are embryonic and adult. For a stem cell to differentiate into a specialized cell type, such as a cardiac or brain cell, it must achieve a “pluripotent” state.
Pluripotent stem cells can potentially develop into any kind of cell in the body and come from three sources:

fetal tissue from miscarriages and abortion
embryos created for in vitro fertility treatments but not selected for implantation
adult cells that have been reprogrammed to embryonic stem cell-like state

Adult stem cells are in many organs and tissues. An adult stem cell is an undifferentiated cell among differentiated cells in a tissue or organ, can renew itself, and can differentiate to yield the major specialized cell types of the tissue or organ.
The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found.
Inducing adult stem cells into a pluripotent state may lead to patient-specific cell therapies that could reduce many of the underlying complications in therapies with embryonic stem cells.
It’s important for research to continue in both cell types. To know how induced adult stem cells need to perform, we must know more about the innate function of embryonic stem cells.

What’s the importance of stem cell research to cardiovascular disease?
Stem cell research could lead to procedures and techniques to reverse degenerative heart disease.
For example, it may help generate new, healthy heart tissue, valves and other vital tissues and structures.
About 128 million people suffer from diseases that might be cured or treated through stem cell research.
About 58 million of these people suffer from cardiovascular disease.

Latest Research News About Heart Failure Source: CardioSmart.org

Every week our cardiologists review the most recent advances in cardiovascular medicine and select news to share with you. Here you will find summaries of some of the latest research news about heart failure.
Share these articles (over 180) with your friends and family via social media, print items you’d like to discuss with your care team, or add them to your toolbox to read later. Go Here

Congestive Heart Failure Clinical Trials Source: CenterWatch.com

A listing of Congestive Heart Failure medical research trials actively recruiting patient volunteers.
Go Here and click on the closest city to find more detailed information on a research study in your area.

Investigators announced for new Heart Failure Research Network Source: American Heart Association Daily Daily News - November 2016

The scientific teams that will lead a new American Heart Association-funded research network charged with unlocking the mysteries behind heart failure have been selected.
The AHA’s Heart Failure Research Network will fund four centers:

Duke University Medical Center, Durham, North Carolina: Researchers will address knowledge gaps related to heart failure and diabetes by studying the biology of the conditions and how to treat them.
Massachusetts General Hospital, Boston: Researchers will study hypertrophy and why not all patients with hypertrophy develop heart failure.
University of Colorado, Denver: Effective drug treatments for heart failure are limited, so the aim is to develop personalized, affordable medications that will benefit a large group of patients.
University of Utah, Salt Lake City: Researchers want to know why a patient and a heart get better with an intervention — a shift from the standard approach of trying to understand why someone gets worse. The goal is to offer new treatment approaches.

“These newly funded research networks targeting heart failure have the opportunity to redefine the disease,” said Clyde Yancy, MD, past president of the AHA and chief of the cardiology division at Northwestern University Feinberg School of Medicine, Chicago, Illinois.
“This work is vitally important, as heart failure will strike one in five of us over 40,” he continued. “This condition is not about ‘them,’ it’s about all of us. We must be tireless in our pursuit of more answers, more therapies and more best practices.”

Heart failure affects nearly 6 million Americans and treatment costs are projected to double from about $31 billion in 2012 to almost $70 billion in 2030.
By 2030, every U.S. adult could be paying $244 each year for heart failure expenses, according to a 2013 policy statement from the AHA.

“The work that will take place at these centers is crucial because heart failure is a growing epidemic as our nation ages , and because we know scientific research is our most powerful tool when it comes to preventing, treating and better understanding all cardiovascular diseases,” said AHA CEO Nancy Brown.

The heart failure network is one of several Strategically Focused Research Networks funded by the AHA.
Others are studying prevention, high blood pressure, disparities, and women and heart disease. The AHA will launch obesity and children networks in 2017.

The Globalization of Heart Failure Research Source: CardioSmart.org

As the demand to have clinically meaningful endpoints in heart failure trials has become greater and the quality and standards of care have improved, the necessary sample size requirements have also increased. Heart failure trials have therefore evolved into “mega trials” requiring an increasingly large number of patients, which necessitates global enrollment. The globalization of clinical trials has resulted in numerous advantages but several challenges, with the ultimate goal of improving cardiovascular human health. The globalization of trials has allowed a harmonization of best practices and definitions, standardization of analytical techniques, and monitoring, and conformity in interpretation of results. However, the diversity in geography has the potential to influence outcomes through differences in practice patterns, standards of care, etiologies of disease, comorbidities, health care systems, and genetics. These challenges all may contribute to variations in outcomes across the globe by geography.

Over the past several decades, there have been important clinical trials that have demonstrated differences in clinical outcomes by continent or geographic region. Whether these differences can be attributed to the geography itself, the delivery of care, background therapy, phenotypes, genetics, environmental interactions, statistical chance, or unknown factors is unclear. However, as we plan clinical trials going forward, we have to take into account the demographics of the potential enrollees so that the underlying foundation of the clinical trial is not jeopardized. New therapies, such as LCZ696 and ivabradine, will be utilized at different rates across the globe, which may influence outcomes in future trials (3,4). Methods need to be put in place to monitor disease severity, practice patterns, and the uptake of new therapies. Clinical trials that enroll large numbers of patients in countries such as Eastern Europe or Russia may find that the length of stay for their hospitalized heart failure patients is longer and that readmission rates at 30 days are lower while having a similar mortality rate. These factors may directly influence the event rates, the choice of primary or secondary endpoint, and the weighted distribution of enrollment from these particular regions of the world. Other factors, such as the use of inotropes, vasodilators, and other therapies, vary broadly across the globe and can potentially interact with the intervention and influence outcomes. Thus, there is a need to attempt to standardize background therapy and to develop manuals of operations that suggest what ideal clinical care should be and which therapies to avoid.

In addition, patients enrolled in the United States are represented by a high percentage of African-Americans who have unique etiologies of heart failure, different background standard therapy (i.e., hydralazine, isosorbide dinitrate), different rates of adherence to evidence-based medicines, and even differences in genetics. Variations in the alpha-2C adrenergic receptor (alpha-2C del 322–325) have been associated with differential responses to therapy, and the frequency of the loss of function variant is approximately 10-fold higher in African-Americans.

Although global clinical trials are necessary to achieve enrollment goals within a reasonable timeframe, a vision and foresight to plan appropriately for the diversity of outcomes is also required. Some of these considerations are:

The planning process should include the approximate percentage of recruitment by various continents, regions, and countries.
The expected variation event rates by region of the world should be considered.
The expected variation in baseline demographics should be incorporated into the planning process.
A detailed manual of operations should be standardized as much as possible for delivery of health care.
Surveillance of patient demographics, practice patterns, and aggregate event rates over time should occur.

In summary, as we highlight the importance of global research in this issue of JACC: Heart Failure, we also want to pay attention to how research is conducted across the globe and where and what the advantages and challenges are to this process.

Clinical Trials Source: National Heart, Lung, and Blood Institute (NHLBI)

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care.
For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat these disorders.

Many more questions remain about heart diseases and conditions, including heart failure.
The NHLBI continues to support research aimed at learning more about heart failure, including:

Finding new therapies for treating heart failure and improving quality of life for people who have the condition.
Creating a new tool for identifying high- and low-risk heart failure patients in emergency departments.
Finding out whether cognitive behavioral therapy can help treat heart failure patients who have depression.
Exploring gene therapy as a possible treatment for heart failure.
Assessing an educational program that aims to improve heart failure outcomes in adults living in rural areas.

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness.
Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available.
You also will have the support of a team of health care providers, who will likely monitor your health closely.
Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail.
You'll learn about treatments and tests you may receive, and the benefits and risks they may pose.
You'll also be given a chance to ask questions about the research.
This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form.
This form is not a contract. You have the right to withdraw from a study at any time, for any reason.
Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to heart failure, talk with your doctor.
You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
Learn more about other heart failure trials and how to participate in a clinical trial.

Two new drugs added to Heart Failure guidelines Source: American Heart Association News - May 20, 2016

A pair of heart failure drugs approved last year by the Food and Drug Administration have made their way into new treatment guidelines. The American College of Cardiology, American Heart Association and Heart Failure Society of America on Friday released updated guidelines that add Corlanor (ivabradine) and Entresto (sacubitril/valsartan).

In an unprecedented move, the release was timed to coincide with the larger release of the European Society of Cardiology’s heart failure guidelines.
The two medications represent the dawning of a new chapter in heart failure treatment, said Clyde W. Yancy, M.D., chair of the U.S. guidelines writing committee and chief of cardiology at Northwestern University’s Feinberg School of Medicine in Chicago.

“We deemed the importance of these two agents and, importantly, instructions for use to be top-of-mind considerations for patients with heart failure and practitioners who treat them,” he said. “These new treatments are not for every patient with heart failure but, when used correctly, substantial benefits are possible.”
Amgen’s Corlanor and Novartis’ Entresto are both twice-a-day pills that cost roughly $4,500 a year, with Medicare and most private insurers covering the drugs. But they are very different compounds. Corlanor works by slowing the heart rate, while Entresto works to relax blood vessels, allowing better blood flow, and decrease counterproductive stress on the heart.

Doctors might prescribe Corlanor to patients whose resting heart rates are 70 beats per minute or higher, despite being on a traditional beta blocker therapy designed to slow the heart rate. Patients with heart rates 70 beats a minute or faster are at increased risk of hospitalization. Therefore, adding Corlanor to beta blocker therapy can better control heart rate and help prevent hospitalizations, Yancy said.

Entresto represents an evolution in heart failure treatment, according to Yancy. It replaces, he said, what was formerly considered part of the foundation in treating heart disease and heart failure: the use of angiotensin-converting enzyme, or ACE, inhibitors.
“Recent compelling data demonstrate that if you treat patients in a traditional manner with therapy, which includes the ACE inhibitor, and then replace that ACE inhibitor with this new combination, remarkably, patients don’t just do a little bit better, they do substantially better,” he said.

Cardiologist Mathew Maurer, M.D., uses Corlanor and Entresto when treating heart failure patients at New York-Presbyterian/Columbia University Medical Center.
“Particularly, I think, that the data is stronger — as the guidelines reflect — for Entresto than it is for Corlanor,” said Maurer, medical director of The HCM Center at New York-Presbyterian. Maurer was not involved in writing the updated guidelines but conducted research on Entresto.
The 2014 study that led to Entresto’s approval showed the drug reduced the risk of dying from cardiovascular causes or being hospitalized for worsening heart failure by 20 percent after more than two years, from 26.5 percent among patients taking the ACE inhibitor enalapril to 21.8 percent among those taking Entresto.

Corlanor’s approval was based on a 2010 study that found 24 percent of those taking the drug had either died from cardiovascular causes or had been hospitalized for heart failure after nearly two years, compared with 29 percent of those taking a placebo. That translated to an 18 percent reduction in risk.
The U.S. guidelines update was released simultaneously with the European Society of Cardiology’s heart failure guidelines, which broadly cover how to best treat and manage heart failure. A complete set of revised U.S. heart failure guidelines are expected within the next year, the organizations said.

Both the European and U.S. heart failure guidelines committees deliberated at the same time and, although functioning independently, reached the same general conclusions, Yancy said. The committees decided a concurrent release of both recommendations might better inform the global community.
“[In] one of the few moments in the evolution of clinical practice guideline statements, all the information will be available from the various governing bodies for public consideration at the same moment, on the same day addressing these important breakthroughs in cardiovascular medicine,” Yancy said.

An estimated 5.7 million Americans have heart failure, a progressive condition in which the heart is unable to efficiently pump blood.
“There has been a dearth of new therapies for patients with chronic systolic heart failure,” Maurer said. “With these therapies we’ve actually advanced the clinical care a tremendous amount and created hope for patients with chronic systolic heart failure that their outcomes could be improved, their quality of life better and, ideally, they can spend more time out of hospital, highly functional and alive.”

Novel Cell Therapy may repair heart damage using modified cells from facial muscle Source: News Medical Life Sciences - February 2017

Researchers at the University of Cincinnati (UC) have received $2.4 million in federal funding to pursue research on a novel cell therapy that would repair heart damage using modified cells taken from the patient's own facial muscle.
"One of the major advantages of this modified cells from facial muin the clinical setting will be that we take cells from the patient themselves to lessen the risk of rejection and tumor formation. These are your own natural cells," says principal investigator Yi-Gang Wang, MD, PhD, a professor in the Department of Pathology and Laboratory Medicine and director of Regenerative Medicine Research at UC's College of Medicine.
Our cell therapy techniques, Wang says, have already been successful in small animal models, with the next step being large animal studies.

"Right now there is very limited heart muscle regeneration after a person has a heart attack," he says, adding that the only treatments that do exist are drug therapies, heart bypasses or heart transplants.
However, current treatments do not replace cells lost during heart attack, and come with additional dangers: reduced oxygen consumption from drug therapy, recovery and complications from bypass surgeries and the availability of a donor heart, which includes the risk of rejection.
"The most promising route from treatment of heart failure due to cardiovascular disease is to use cells that can promote the regrowth of healthy tissue," he says.

Over the last decade, Wang's research team has determined that facial muscle cells (masseter cells) develop in close proximity to heart muscle cells (cardiomyocytes) and have similar gene expression. By removing certain skeletal muscle genes and enhancing cardiac genes, masseter cells can be 'reprogrammed' into cells that have an identical genetic make-up to cardiomyocytes, including the ability to spontaneously beat in order to pump blood.

These masseter cells turned cardiomyocytes would then be administered via injection or a patch, Wang says.
"Our small animal studies already show it is feasible," says Wang, "and our techniques are the most efficient at generating cardiomyocytes."

Congestive Heart Failure: When it's time to talk Transplant Source: Health.USNews.com - April 2015

For many people with congestive heart failure, a wide assortment of medical, surgical and lifestyle treatments allows them to go on with their lives. Yet others are clearly on a steep decline. When patients can no longer stay out of the hospital or can barely function, experts say, they've reached the point when it's time to talk heart transplant.

Running Out of Options
“Heart transplantation is an option for patients only if they have no other options,” says Dr. Mary Norine Walsh, medical director of heart failure and cardiac transplantation at St. Vincent Heart Center in Indianapolis, which performs 20 to 25 transplants a year.
In addition, candidates for transplant can have no disqualifying factors. Among others, that means patients can’t be morbidly obese or current smokers. So part of the discussion groundwork is encouraging patients to make significant lifestyle changes.

For heart failure patients, Walsh says, transplant usually comes at the end of a long road. They’ve been through stent procedures or bypass surgery. They take strong medications – ACE inhibitors, beta-blockers and aldosterone antagonists – to forestall the disease process. Many have defibrillator implants.
When those measures fail, Walsh says, when patients’ fatigue and shortness of breath continue to worsen, even at rest, “We may begin to think that heart transplantation is the best choice for them.”

Who’s Eligible?
The Johns Hopkins Comprehensive Transplant Center performs between 20 and 30 heart transplants a year, says Dr. Ryan Tedford, a cardiologist at Hopkins. While the upper age limit for heart transplant varies with each institution, 70 is the Center's cutoff.
Doctors consider many factors when evaluating patients for transplant, including analyzing tests of liver and kidney function to determine whether poor blood flow is hampering the vital functions of these organs. One telltale sign of worsening heart failure, Tedford says, is a steady rise in the doses of diuretic drugs – used to relieve fluid buildup in a patient’s abdomen, feet, ankles, legs and lungs.

Patients being evaluated also undergo cardiopulmonary exercise testing. “It measures oxygen consumption and allows us to predict how well a patient’s going to do over the next year,” he says.

That one-year yardstick comes up repeatedly when experts talk about transplant candidates. “If I had a patient who I think has life expectancy better than that, I would never want to transplant them,” Tedford says. “But if it’s below that, and significantly below that, that’s when I will start to do an evaluation for a heart transplant or a heart pump.”
A mechanical heart pump – called a left ventricular assist device – is used as a bridge to help very sick patients survive while awaiting a donor, or as an alternative for those who either don’t want or aren’t eligible for heart transplant. Another piece of the transplant evaluation is determining whether patients have enough support at home to help them through the arduous process, Tedford adds. "We require, for the first couple weeks in particular, that patients have 24-hour care," he says. While the goal is for patients to leave the hospital and function independently, that's not always the case, with some patients requiring more care and rehab. And with all patients on "sternal precautions" after the surgery, they need someone to drive them to appointments, including weekly heart biopsies for a month post-transplant.

Trading Problems
Dr. John Boehmer is co-director of the heart failure program at Penn State Hershey Heart and Vascular Institute, which performs about 17 transplants a year. Experts agree that when patients undergo heart transplant, they’re exchanging one set of problems for another.
Rejection of the donor heart is “fairly common” in the first three to six months after transplant, Boehmer says. Intravenous medications to suppress the immune system – and prevent rejection of the donor heart – start during surgery. Afterward, patients undergo repeated heart biopsies to monitor for signs of rejection.
The downside of anti-rejection medicines is that they leave patients susceptible to opportunistic infections. Patients are closely monitored for fever and elevated white blood cell count, and treated as needed. Bleeding complications from surgery are possible, Boehmer says. And because transplant is an open-heart procedure, stroke can occur. “But the good news is that in the majority of cases, we can manage complications,” he says. High blood pressure is a common transplant drug side effect requiring treatment, he adds.

Walsh notes “very significant” tremors can be a side effect of transplant drugs, but that should improve over time. Higher-dose steroids, used soon after transplant, can cause some patients to develop muscle weakness, she says, for which physical therapy can help.
Boehmer says survival is “well over 97 percent in the early perioperative period,” and about 87 percent at one year. “Somebody who lives after the first year – their conditional survival after surviving that long is much greater than 10 years,” he says.
When choosing a heart transplant center, patients should ask about the center's specific outcomes, he suggests.

Precious Resource: Donor Hearts
Patients deemed eligible for transplant are enrolled in the United Network of Organ Sharing. Patients are ranked, with highest priority given to the sickest. Currently, 4,135 U.S. patients are waiting for hearts from deceased donors, according to the UNOS website. “The waiting times vary greatly depending on blood type, body size, preformed antibodies and the some other variables,” Boehmer says.

Walsh says donor organ availability also varies by region of the country. For example, wait times are much shorter in Southern California than the Indiana region where she practices. When it comes to your personal organ donor wishes, she says, “Make sure it’s not just on your driver’s license but that your loved ones know what your preferences and intentions are.”

Psychological Services
For people on the transplant waiting list, it’s an anxious time. Transplant programs include psychiatric evaluation, treatment and referral for ongoing counseling, Boehmer says. “We also have clergy,” he adds, and the transplant team works closely with palliative services, even with some patients receiving aggressive medical or surgical therapies.
Transplant patients experience a roller-coaster ride of emotions. “Usually there’s an initial elation that they got through the operation,” Boehmer says. While certain medications, particularly high-dose prednisone, can cause mood swings raging from euphoria to depression, most patients can be weaned off these drugs.

Even patients who do well can have initial anxiety about going home, he adds. “They’re no longer monitored. They no longer have a defibrillator in case their heart stops.” And caregivers – who’ve been subjected to enormous stress and shouldered many responsibilities during their loved one’s illness and treatment – now must adapt to a “new normal," Boehmer says.

After Surgery
Other than artificial heart surgery, heart transplant is “the only surgery where the heart is taken entirely out of the body,” Walsh notes. So it’s quite dramatic. Post-op patients stay in the coronary care unit anywhere from two to five days, she says, but it can be much longer, even weeks, if they have a complicating illness.
For some transplant patients, life “can be completely normal,” Walsh says. “People recover and return to work and school and do whatever they wish,” including athletics. For the heart team members, it’s gratifying to see how well patients can do.

“We have one young lady who was transplanted as an adolescent – and now she’s in her 30s with two young kids,” Boehmer says. If donor families wish, they can meet with heart recipients who reach out to them. Otherwise, donor anonymity is respected.
Walsh says as patients become stable, the team goes from seeing them “very intensely, sometimes weekly” to having them check in just twice a year. “Any transplant cardiologist will say we occasionally end up missing our patients,” Walsh says. Do patients miss frequent staff encounters in return? No, she says: “They probably don’t.”

U.S. Heart Failure Rates on the Rise Source: WebMD; HealthDay Reporter - January 2017

Heart failure rates are going up in the United States, according to a new report from the American Heart Association.
The same report also said that heart disease remains the leading cause of death in the United States, even as the death rate from heart disease is heading down.
The number of American adults with heart failure, in which the heart is too weak to pump blood throughout the body, rose by 800,000 over five years, the American Heart Association (AHA) said in the report released Thursday.

The number of people with heart failure is expected to rise by 46 percent by 2030. That means 8 million people will have heart failure by then. Reasons for the rising number of Americans with heart failure include an aging population and a growing number of heart attack survivors, who are at increased risk for heart failure.
Cardiovascular disease includes all types of heart disease, high blood pressure and stroke, the heart association noted in an AHA news release.

Heart disease and stroke are the two top causes of death worldwide. In the United States, heart disease is first and stroke is fifth, according to the AHA's 2017 Heart Disease and Stroke Statistics Update.
In the United States, more than one-third of adults (92 million) have cardiovascular disease. In 2014, nearly 808,000 Americans died from cardiovascular disease.
However, one bright spot in the update is that deaths from cardiovascular diseases fell more than 25 percent from 2004 to 2014.

Heart attacks strike about 790,000 people in the United States each year, and kill about 114,000. The update found similar numbers for stroke. In 2014, about 795,000 Americans had a new or repeat stroke, and 133,000 of them died.
Americans had more than 350,000 out-of-hospital cardiac arrests, that's when the heart suddenly stops -- and nearly 90 percent were fatal.
In 2013, cardiovascular diseases were the leading cause of death worldwide, claiming more than 17 million lives, the association said.

The AHA report also noted that cardiovascular disease disparities persist in the United States.
"We know that advances in cardiovascular health are not distributed evenly across the population," Dr. Emelia Benjamin, chair of the update's writing group, said in the news release. She's a professor of medicine at Boston University School of Medicine.

"In particular, individuals who live in rural communities, have less education, have lower incomes, and are ethnic or racial minorities have an undue burden of cardiovascular disease and its risk factors," Benjamin said.
The update had one other bit of positive news, physical activity increased more than 7 percent from 1998 to 2015.