Researchers and healthcare professionals must find new ways to build on scientific successes to combat the growing worldwide epidemic of heart failure, American Heart Association President Mariell Jessup, M.D., said during her Presidential Address.
In her address to gathered scientists, healthcare providers and others during the association’s annual Scientific Sessions meeting on Sunday, Jessup detailed important breakthroughs in recent years and called for more research, prevention and innovation in heart failure.
“We are standing on the firm foundation of early studies in heart failure … our past successes. Yet we have so much more to do,” said Jessup, Professor of Medicine at the University of Pennsylvania School of Medicine and Medical Director of Penn’s Heart and Vascular Center.
Jessup outlined the “remarkable yet troubling history” of the disease that affects 23 million people worldwide, detailing significant clinical trials, scientific advancements, new therapies and personal stories from more than 30 years of practice.
Heart failure is when the heart can’t pump enough blood to the organs. The heart works, but not as well as it should. Heart failure is almost always a chronic, long-term condition.
Jessup described how scientific breakthroughs have helped people live longer in general, and particularly after myocardial infarctions – but pointed out that older people and heart attack survivors are more susceptible to heart failure.
“Heart failure is, very strangely, an epidemic of scientific success,” she said.
Jessup described many important advances since the early years of her career. Then, for some heart failure patients, “we could only stand by helplessly, with few ways to save them.” Jessup detailed the steady progress over the years in heart failure.
She discussed several clinical trials that have helped patients, including one known as “VHEFT 1” that was published in 1986 and “produced the first glimmer of hope that mortality could be postponed in patients with chronic heart failure.”
To illustrate the impact of these and other developments, Jessup highlighted the case of one of her patients with heart failure, a man named Tony whom she first started seeing in 1982. He has seen remarkable improvement based on beta blocker medications, participation in several trials and a CRT pacemaker.
Tony, now 87, now has normalized cardiac function..
“Tony is a shining example of a nearly miraculous improvement in survival over the past three decades,” she said.
Jessup urged not only more research and prevention into heart failure, but also development of strategies to keep patients out of the hospital.
There are too many hospitalizations and an unacceptably high 30-day mortality rate, Jessup said, pointing out the combined mortality and readmission rate of 30 percent within 90 days after discharge.
“Actually, we have to truly understand what our patients value most – avoiding hospitalization or living longer,” she said. “There may be outcomes worse than death for some patients. We must help them find harmony with their disease, and learn what that means for each patient.”
Jessup told another compelling story about a patient.
She described how many years ago she saw a 22-year-old woman named Elaine, who had just given birth and was in severe heart failure. She initially appeared to have post-partum cardiomyopathy. Eventually, Jessup and her team were forced to perform a heart transplantation to save her.
“She was able to care for her newborn daughter for a few years,” Jessup said. “But sadly, she succumbed to complications. … She was just 29 years old.”
Twenty years later, Jessup saw another young woman with dilated cardiomyopathy. This woman, 19-year-old Jessica, was becoming more symptomatic.
During their initial interview, Jessica described how her own mother developed heart failure after giving birth to her and died.
“As I asked more questions, it dawned on me suddenly – Jess was Elaine’s daughter!” Jessup said. “I was watching the cycle of familial cardiomyopathy repeat itself before my eyes.”
The story of Elaine and her daughter is a tragic and hopeful tale of advances in heart failure treatment. Elaine’s life could be extended only very briefly just a few decades ago. Yet, thanks to scientific advancement, Jessica is thriving.
She recently married and finished nursing school. She exercises vigorously and is working full time. She even finds time to volunteer for the American Heart Association, sharing her story and urging lawmakers to fund more scientific research.
“Everyone here knows Jess’ plea is vital for heart failure patients everywhere,” Jessup said. “Her plea also prompts a question that troubles me deeply: What must we discover that will guarantee Jess a healthy future?
“We must find new ways to help our patients to live longer, and to enjoy the things that really matter.”
“Please meet Tony, the face of our many and valuable past successes. … and Jess, the face of our future challenges,” Jessup said, leading the audience in a round of applause before hugging each of them.