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Australians with mild heart failure gain access to cardiac device therapy

23 July 2014

Interview with Prof. Andrew D McGavigan, Flinders Medical Centre, Adelaide. Chairperson of the CSANZ Electrophysiology & Pacing Council.

Heart failure affects millions of Australians. Would you mind explaining the causes of heart failure?
Prof: Heart failure occurs when the heart isn’t pumping enough blood to meet the body’s needs. As a result, fluid may build up in the legs, lungs and other tissues throughout the body. Heart failure can be mild, severe or even life-threatening. The most common cause of heart failure is heart muscle damage due to coronary artery disease. Heart damage can also be caused by high blood pressure (hypertension), heart valve disease or can be idiopathic.

What symptoms might a person with heart failure experience?
Prof: Symptoms of heart failure aren’t always obvious. Some with early stage heart failure may not have any symptoms at all and others might dismiss symptoms for signs of old age. Because of the heart’s inability to efficiently pump blood, fluid often builds up in the lungs or extremities, leading to the cardinal symptoms of shortness of breath and swelling of the feet and legs. However, heart failure can produce many other symptoms which include: feeling tired; lack of energy; difficulty sleeping at night due to breathing problems; loss of appetite; impaired memory and/or confusion; and increased urination at night. Some or all of these symptoms may indicate heart failure.

Is heart failure generally diagnosed by a GP, or should a person be referred to a Cardiologist or Electrophysiologist?
Prof: Breathlessness and ankle swelling are common symptoms and can have many causes. Assessment through history, examination and performing tests may help confirm the underlying diagnosis and allow effective treatments to be given. Several tests are available to help diagnose heart failure, look for the underlying cause and determine how far the condition has progressed. Tests include an echocardiogram, electrocardiogram, chest x-ray, exercise test or cardiac catheterisation. General Practitioners have an important role to play as they will often be the first to assess patients with possible heart failure and often will order or conduct some of these tests. However, if the diagnosis is confirmed, many patients will benefit from a specialist opinion from a Cardiologist as the prognosis, severity and complex nature of the condition can differ dramatically. Some patients may need to be referred to a Heart Failure Cardiologist and many will require assessment by a Cardiac Electrophysiologist for suitability for implantable device therapy such as implantable defibrillators and cardiac resynchronisation therapy.

What treatment options are available?
Prof: Depending on the diagnosis, there are a number of treatment options available to help manage heart failure. Lifestyle changes such as limiting sodium (or salt) intake, quitting smoking or losing weight can help relieve some of the symptoms and reduce strain on the heart. A variety of medications are used for treating heart failure, sometimes in combination. This varies for the individual and should be discussed with a doctor.

In some people with heart failure the lower chambers of the heart don’t beat at the same time, forcing the heart to work harder. Cardiac resynchronisation therapy may benefit these patients. In this case a pacemaker cardiac resynchronisation therapy enabled with sends small electrical signals to the lower chamber of the heart to help them beat in sync, intending to improve the pumping efficiency of the heart. Some patients with heart failure are at increased risk of sudden death and this risk can be reduced by a device called an implantable defibrillator. This is often combined with resynchronisation therapy.

Heart failure can be made worse by a weak heart valve. For these patients, heart surgery may be recommended to repair or replace the valve. If heart failure is serious or irreversible, a heart transplant might be considered.

Do treatment options differ around the world?
Prof: Treatment guidelines for heart failure exist around the world. Mostly, classification of heart failure and treatment recommendations are on par. Access to treatments are dependent upon local healthcare systems and the Government. In Australia, the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure are utilised.

The Medicare Benefit Schedule recently listed a new code for mild heart failure. Can you please explain what this means?
Prof: Until now, people with mild heart failure were denied access to life-saving cardiac device therapy despite international and local guidelines. The Government’s decision to make this procedure available for Australian patients for the first time brings us on par with the rest of the world and aligns with both international and local clinical guidelines in the treatment of heart failure meaning more Australian lives can be saved.

Cardiac resynchronisation therapy has clear-cut benefits for patients with mild heart failure and is proven to reduce risk of mortality and injury. Clinical studies demonstrate this therapy reduces hospitalisations and prevents disease progression. We welcome this access for Australian patients.

Finally, what is your advice for someone who has a symptom of heart failure, or has recently been diagnosed?
Prof: Anyone with symptoms of heart failure should definitely see their GP or Cardiologist for a Heart Health check. People with heart failure can live well when diligent in their personal health management and with appropriate treatment.

*The views and opinions expressed are those of the individual poster and not representative of Medtronic or the third parties referenced.

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