David Kass says all failing hearts aren’t created equal and physicians may want to adjust their remedies.
Half of America’s 5 million cases stem from “systolic” heart failure, which leaves patients feeling perpetually fatigued.
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| Is it time to tailor treatment for heart failure? David Kass says all failing hearts aren’t created equal and physicians may want to adjust their remedies. Half of America’s 5 million cases stem from “systolic” heart failure, which leaves patients feeling perpetually fatigued. | |
Cardiologists typically prescribe beta blockers, which reduce the toxic effects of the neurohormones that tax the heart muscle. Patients with the lesser-known “nonsystolic” heart failure also typically get beta blockers, but for a different reason. Cardiologists hope that by slowing their hearts, the organ’s chambers will have time to fill with more blood before pumping it out to the rest of the body.
But Kass, an expert on heart failure, says therapies for nonsystolic cases should be revisited. This problem is harder to detect, because the heart’s pumping strength can look normal when the patients are at rest, the scenario in a doctor’s office. Yet when these same patients become active, their hearts fail to deliver. Tasks as simple as getting dressed in the morning leave them gasping for breath.
When these patients are properly diagnosed, Kass says, treating them with beta blocker therapy might have an undesirable effect. Why would a cardiologist want to slow down a patient’s heart when it needs to speed up? Kass suspects these patients would be better served by pacemakers, which can detect physical activity and then adjust the heart rate accordingly.
This approach could be critical. More than half a million heart failure cases develop yearly, and nonsystolic cases are growing. “It’s mostly women over 50,” Kass says, “whose heart pumping appears to be normal.” Further examination reveals their disease.
To come up with his premise, Kass compared 19 such patients to 17 with similar cardiac issues but no symptoms of heart failure. When both groups pedaled stationary bicycles at increasing speeds, those with nonsystolic heart failure quickly fell behind. On average, their hearts beat 44 percent slower than the other patients’. Similarly, the affected group’s blood vessels failed to dilate adequately in response to activity.
But Kass wants to go deeper. He’ll study 80 nonsystolic heart failure patients with pacemakers. Half will receive beta blockers; half won’t. Which ones will feel better?
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The Johns Hopkins Division of Cardiology