| Treating
Heart Failure
The George M. and Linda H. Kaufman Center for Heart Failure offers a comprehensive, integrative approach to the research, diagnosis and treatment of heart failure and cardiomyopathy. The Kaufman Center brings together a team of experts from multiple disciplines, including medicine, surgery, electrophysiology, cardiovascular imaging, and basic and clinical research, providing an effective process for heart failure care.
Since 2000, there have been over 7,000 annual heart failure patient visits to the Kaufman Center, including 616 new patient visits in 2004. The Kaufman Center and referring physicians partner together to provide ongoing, cutting-edge heart failure treatment. Our physicians utilize the combined resources of the Heart and Vascular Institute to accurately diagnose the cause of each patient’s heart failure, which enables the implementation of optimized treatments for the heart failure.
Diagnostic
Capabilities
The Kaufman Center
for Heart Failure offers a full range of diagnostic capabilities for heart
failure. These include:
- Cardiovascular
risk factor screening
- Full range of heart
failure laboratory testing, including BNP
- Electrocardiography
- Echocardiography,
including transesophageal and Doppler studies
- Full range of cardiac
nuclear medicine procedures, including radionuclide ventriculography
and positron emission tomography (PET)
- Magnetic resonance
imaging (MRI) and spectroscopy
- Stress testing
and Holter monitoring
- Endomyocardial
biopsy
- Outpatient cardiac
catheterization
- Intracoronary ultrasound
Medical
Management Of Heart Failure
The
Section of Heart Failure & Transplantation physicians medically
manage heart failure patients with the newest, state-of-the-art medications
to slow the disease's progression, keep patients out of the hospital,
and reduce mortality. In addition, we continue to research new inotropic
drugs, new vasodilating drugs, and new diuretics for heart failure treatment. Click
here to learn more about medical trials
for heart failure
Women
and Heart Failure
Despite the fact that
women account for nearly 50% of all hospital admissions for heart failure,
only 25% of women are involved in heart failure studies. The Center for
Women and Heart Failure was developed in 2005 to improve the care of women
with heart failure via education, treatment, and research. Our goal is
to focus more attention on women in heart failure research so that we
can eventually tailor therapy to meet individual heart failure treatment needs. Click
here to learn more.
Outcomes
Guide Treatment
Cleveland Clinic is
a past winner of the prestigious Ernest A. Codman Award, which recognizes
excellence in the use of outcomes measurement by health care organizations
to achieve improvements in the quality and safety of health care.This
award was granted to Cleveland Clinic heart failure clinicians for optimizing
the use of ACE inhibitor drugs in high-risk congestive heart failure patients
with severe systolic dysfunction.
The positive effect
of ACE inhibitors on reducing mortality, morbidity and hospital readmission
rates is well- recognized. Other similar outcome studies help clinicians
in the Kaufman Center for Heart Failure provide more effective therapies.
Cardiac Resynchronization
Therapy
Heart Center electrophysiologists
are providing resynchronization with biventricular pacing (both with and
without defibrillators) which are improving quality of life, decreasing
hospitalizations and improving mortality in patients with advanced heart
failure. Biventricular pacing ICD system implants have increased from
64 cases in 2001 to 183 cases in 2004. Click
here for more information about cardiac resynchronization therapy (CRT)
Patients who have both an arrhythmia (irregular heart rhythm) and heart
failure may benefit from a combination biventricular pacemaker and implantable
cardioverter-defibrillator (ICD). The ICD detects rapid, life-threatening
heart beats and immediately delivers electrical energy to restore a normal
heart rhythm. The two therapies combined can improve heart function, quality
of life and decrease mortality (death) in appropriate patients. Click
here for more information about ICD therapy
Heart
Failure Management Program
Initiated in 1999, the Heart
Failure Management Program doctors and nurses provide frequent contact
with patients (through office visits, telephone calls or home monitoring)
to alleviate symptoms, prevent symptoms from recurring and decrease the
need for emergency care or hospitalization. In this program, emphasis
is placed on increasing patient's knowledge of heart failure and helping
to self-manage this condition. For health care professionals: Click
here to learn more about our disease management algorithms.
Heart Failure Surgery
Transplant Program
- The Cleveland Clinic
Cardiac Transplant Program is a recognized leader in the field, remaining
the leading center in Ohio and the Mid-West. We have the fourth largest
heart transplant program in the country.
- The Cleveland
Clinic Cardiac Transplant Program started in 1984, and 1,125 transplants
have been performed as of December, 2004. Our
Cardiac Transplant Program is one of only three centers in the United
States to have performed more than 1,000 cardiac transplants.
- Despite the significant
pharmacological and surgical advances in the treatment of heart failure,
many patients will continue to progress to advanced, end-stage failure.
For these patients, cardiac transplantation remains the most effective
treatment option. We continue to achieve excellent outcomes following
heart transplant. Results from the January 2005, annual report of the
Scientific Registry of Transplant Recipients (SRTR) indicated higher-than-expected
survival rates at the Cleveland Clinic Cardiac Transplant Program, based
on the disease severity of our transplant recipients. Our survival rates
are 97 percent, 93 percent, and 81 percent survival at 30 days, one
year and three years, respectively.
Click
here to learn more about the Cleveland Clinic Transplant Program
Alternative
Surgical Strategies
In response to the
continued decrease of organ donors, the Heart Center increased the use
of alternative surgical strategies for end-stage heart failure.
Clearly, our heart
transplant program delivers strong results for our patients, but with
organ availability continuing to be the defining issue in transplantation,
physicians in the Kaufman Center are focusing a great deal of attention
on alternative therapies for the treatment of heart failure. Improved
outcomes in this population with the use of "conventional" surgical
therapies, such as coronary artery bypass and valve repair, have resulted
in an increased application of these procedures.
Mechanical Circulatory
Support
The Kaufman Center
offers unparalleled expertise in the field of mechanical circulatory support.
Mechanical circulatory support has been utilized for acute support as
a bridge-to-transplantation, and is now available for long-term support
for patients who are not candidates for transplantation.
- For more than
a decade, surgeons in the Kaufman Center have successfully utilized
the strategy of left ventricular assist devices (VAD) as bridge-to-transplant.
In the critically ill patient awaiting cardiac transplantation, the
VAD provides effective hemodynamic support, maintains or improves other
organ function, allows exercise performance and rehabilitation better
than possible for those patients treated medically, and importantly
provides for discharge to an outpatient setting. Since the inception
of the Kaufman Center, over 500 patients have been supported with various
devices. In 2004, 19 patients were supported with four different left
ventricular assist devices.The benefit of this therapy is reflected
in a survival of 84%, 74%, 64%, and 55% at 30 days, 3 months, 1 year,
and 4 years after embarking on the strategy of VAD bridge to transplant.
This includes mortality during VAD support as well as that after transplant.
- Lessons learned
with the bridge to transplant experience have resulted in our ability
to provide VAD as permanent or “destination” therapy. For
selected individuals with severe, refractory heart failure, the Kaufman
Center has been approved by CMS to offer this life saving therapy. Click
here to learn more about destination therapy clinical trials.
- The Cleveland Clinic
is one of the few institutions worldwide which has access to all FDA
approved devices, as well as new investigational devices. This allows
us to choose the device which will best suit an individual patient's
clinical needs. Milestones in 2004 include the insertion of two Heartmate®
II continuous flow pumps, three Abiomed AB5000™ ventricles, and
participation in two randomized ventricular assist device trials (Reliant
and Delta) for destination therapy.
Click
here to learn more about VAD
Specialists in the
Kaufman Center for Heart Failure are continuing to aggressively pursue
medical, surgical and device-based therapies, both conventional and novel,
for patients with heart failure.
High Risk Conventional
Surgery
High-risk "conventional"
surgeries such has coronary artery bypass and valve repair or replacement
have resulted in an improvement of symptoms for many patients.
Click here for information
on:
Left Ventricular
Reconstruction Surgery (Dor)
- One surgical method
for end-stage heart failure is the left ventricular (LV) reconstruction
procedure for ischemic cardiomyopathy. In the failing heart, the normal
elliptical ventricular shape is lost and is replaced by a dilated, spherical
muscle or remodeled ventricle. This surgery helps to improve ventricular
function by reversing this remodeling of the heart such that the shape
of the ventricle subsequently becomes more normal and the mechanics
of contraction improve. Click
here to learn more
- Since 1997, we
have performed more than 300 LV reconstructions as part of a comprehensive
surgical management of ischemic cardiomyopathy. A recent review of this
experience demonstrated survival of 98%, 92%, 90%, and 86% at 30 days,
1, 2, and 3 years respectively. As important, we demonstrated a significant
reduction in hospitalizations for heart failure.
Innovations:
Research into New Methods of Treatment
-
| Experimental
procedures |
|
| Acorn
Corcap™ |
Acorn
CorCap™ device :
The
Acorn CorCap® is a mesh-like polyester “jacket” that
is surgically wrapped around a dilated left ventricle to help restore
an enlarged heart to a more normal size and shape. Placement of the
Acorn CorCap® can be performed during other cardiac procedures.The
Cleveland Clinic was integrally involved in a world-wide randomized
trial utilizing this device. Nicholas
Smedira, M.D., and Randall
Starling, M.D., M.P.H., , were the Cleveland Clinic co-principal
investigators. In Fall 2004, clinical trial results presented at the
American Heart Association Scientific Sessions indicated that patients
treated with this device:
- Demonstrated sustained
improvements in heart size and shape
- Showed significant
improvements in quality of life using standardized evaluation methods
- Were 50 percent
less likely to require additional cardiac procedures for worsening heart
failure, such as transplants and implants of ventricular assist or electrical
stimulation devices
The trial sponsor
has submitted these results to the FDA for approval so that this viable
treatment option can be made available to appropriate heart failure patients
in the United States. The Acorn CorCap® is currently approved in Europe.
(To
learn more about Acorn, go to http://www.acorncv.com)
- Implantable
Hemodynamic Monitor in Patients with Heart Failure: The
HeartSensor® is similar in size to a pacemaker and measures critical
clinical factors such as intracardiac pressure. Daily pressure readings
are conducted via home monitoring devices and the data is transferred
over a phone line to the physician.The HeartSensor® may help physicians
to better manage patients with heart failure. Medications can be adjusted
as necessary, and the device serves as an early warning before physical
symptoms are manifested.
- Stem Cell
Research: Stem cells are naturally recruited to the site of
a myocardial infarction (heart attack) for up to five days following
the event, but are not recruited days or weeks later, even when stem
cells are mobilized in the bloodstream. Marc S. Penn, M.D., Ph.D., has
pioneered the development of Stromal Cell-Derived Factor 1 (SDF-1).
Autologous skeletal myoblasts are modified to over-express SDF-1 and
are then transplanted in the infarct zone (damaged area of the heart
muscle) eight weeks after a heart attack. Mobilized stem cells are then
“homed” to the area of the infarct and form new blood vessel
tissue. For more information on stem cell studies, please see -
• Cell
Transplant: Therapy to Repair Failing Hearts
• Mobilizing
Stem Cells to Repair MI Damaged Hearts
• Angiogenesis
- AlloMap™
Molecular Expression Testing: The
Cleveland Clinic Heart Center was one of eight leading transplant centers
involved in the Cardiac Allograft Rejection Gene Expression Observational
(CARGO) study to evaluate peripheral blood gene expression for cardiac
transplantation acute rejection management. AlloMap testing is a new
blood sample based test developed to manage the complex immunologic
questions posed by cardiac transplant patients.
Traditionally, a heart transplant patient has multiple biopsies on his/her
transplanted heart (called an allograft), to detect evidence of rejection.The
AlloMap molecular expression test offers a technologically advanced,
less invasive alternative and is designed to reduce the need for endomyocardial
biopsy. Click here
to learn more*
*a new browser window
will open with this link. The inclusion of links to other web sites does
not imply any endorsement of the material on the web sites or any association
with their operators
For more information
on the diagnosis and treatment of heart failure, see the Heart
Failure Heart Guide
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