Nav: Home

In heart failure, a stronger heart could spell worse symptoms

November 20, 2018

PHILADELPHIA, Nov 20 -- Heart failure patients fall into two general categories: those with weaker hearts, and those with stronger, but stiffer hearts that continue to eject the normal volume of blood with every beat. Although their hearts have different pump strength, new research shows that both groups suffer from similar levels of physical and cognitive impairments after a hospitalization for their heart failure, and that surprisingly, patients with stronger hearts have higher rates of depressive symptoms and lower quality of life.

"The results speak to how bad heart failure is across the board," says senior author Gordon Reeves, MD, Associate Professor of Cardiology at the Sidney Kimmel Medical College at Thomas Jefferson University. "Heart failure is one of the most common reasons for older patients to be in the hospital and the issues experienced as a consequence of a heart failure hospitalization can have a huge effect on their daily function and independence. This appears to be true regardless of the pumping function of the heart and, in some regards, may actually be worse in those in whom the squeezing function is preserved." The results were published online in the journal Circulation: Heart Failure.

Many treatments for heart failure - for example medications like angiotensin converting enzyme inhibitors or beta blockers, and certain types of pacemakers, -- are only effective in patients with weaker hearts, those with a so-called reduced ejection fraction (rEF), meaning the main pumping chamber of their heart pumps out or ejects a smaller portion of blood than it should with each heartbeat. Heart failure in patients with stronger hearts, those with preserved ejection fraction (pEF), is actually the most common form of heart failure in older adults and is more likely to affect women, but there are far fewer effective therapies currently available.

"This research gives us a much clearer picture of the symptoms and potential barriers to successful care affecting older patients with both reduced and preserved ejection fractions following a heart failure hospitalization, and gives us new insight into the interventions that might improve their quality of life and clinical outcomes," said Dr. Reeves.

Dr. Reeves and colleagues from the coordinating center, Wake Forest School of Medicine, and Duke University Medical Center analyzed data from the first 202 patients enrolled in the ongoing multi-center REHAB-HF (NIH study number: NCT02196038) clinical trial. The overarching goal of that study, which aims to enroll 360 patients, is to determine the benefit of rehabilitation interventions for older patients recovering from a heart failure hospitalization who may find it challenging to complete the types of physical activity that are included in traditional cardiac rehabilitation. In fact, such patients are currently excluded from participating in cardiac rehabilitation by CMS policy because there has been so little prior research in these patients. The early baseline analysis presented in this interim report, is the first to look at the differences in physical performance, frailty, depression and cognition between preserved and reduced ejection fraction patients.

In an accompanying editorial, Kelsey M Flint, MD from Rocky Mountain Regional VA Medical Center and Daniel E Forman, MD, from the University of Pittsburgh Department of Medicine; say that this characterization is significant, because heart failure is a condition that hasn't been fully addressed by current standards of care. "Over 70% of Medicare beneficiaries who are hospitalized for heart failure (HF) die or are re-hospitalized by one year after discharge," the editorial authors write.

Using a number of assessments more common in the field of geriatric medicine than cardiology, the researchers found that both types of patients scored equally poorly on measures of physical ability, such as walking speed, getting up from a chair unassisted and endurance. They had similar scores on measures of frailty and also cognitive impairment. However, depression and quality of life scores were consistently lower in patients with preserved ejection fractions, or stronger hearts.

"We think of these results as a call to action for the cardiology community," said Dr. Reeves. "These findings indicate we need to do more than decongesting the hearts of these patients."
-end-
Article reference: Haider J. Warraich, Dalane W. Kitzman, David J. Whellan, Pamela W. Duncan, Robert J. Mentz, Amy M. Pastva, M. Benjamin Nelson, Bharathi Upadhya, and Gordon R. Reeves, "Physical Function, Frailty, Cognition, Depression and Quality-of-Life in Hospitalized Adults ?60 Years with Acute Decompensated Heart Failure with Preserved versus Reduced Ejection Fraction: Insights from the REHAB-HF Trial," Circ-HF, DOI: 10.1161/CIRCHEARTFAILURE.118.005254, 2018.

Media contact: Edyta Zielinska, edyta.zielinska@jefferson.edu, 215-955-7359.

Thomas Jefferson University

Related Heart Failure Articles:

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.
Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.
How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.
Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.
NSAID impairs immune response in heart failure, worsens heart and kidney damage
Non-steroidal anti-inflammatory drugs, or NSAIDs, are widely known as pain-killers and can relieve pain and inflammation.
Heart cell defect identified as possible cause of heart failure in pregnancy
A new Tel Aviv University study reveals that one of the possible primary causes of heart failure in pregnant women is a functional heart cell defect.
In heart failure, a stronger heart could spell worse symptoms
Patients with stronger-pumping hearts have as many physical and cognitive impairments as those with weaker hearts, suggesting the need for better treatment.
Patients with common heart failure more likely to have lethal heart rhythms
New Smidt Heart Institute Research shows that patients with Heart Failure with Preserved Ejection Fraction (HFpEF) are more likely to have lethal heart rhythms.
Why does diabetes cause heart failure?
A Loyola University Chicago Stritch School of Medicine study reveals how, on a cellular level, diabetes can cause heart failure.
Oxygen therapy for patients suffering from a heart attack does not prevent heart failure
Oxygen therapy does not prevent the development of heart failure.
More Heart Failure News and Heart Failure Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.