Heart failure affects 3%–5% of people aged over 65 years in Western societies and 10% of those over 75, with a lifetime risk of developing heart failure of about 20% in both men and women.
Needless to say this is an epidemic of heart failure! Statistics from United States illustrate that millions of American suffer from an epidemic of heart failure.
Overall, about 5 million people in the USA suffer from heart failure, a condition in which a weakened heart doesn't pump enough blood. Doctors diagnose 550,000 new cases each year, an epidemic of heart failure is driven by an aging population and a parallel epidemic of high blood pressure — reported this week to have grown over the past decade to include nearly 1 in 3 adults.
Studies show that about half of patients with heart failure survive longer than five years. Nearly 300,000 die each year, many of them waiting for donor hearts. Considering that just about 2,000 donor hearts become available every year, the number of people who could benefit from a bridge pump like the CardioWest is relatively small. But the scarcity of donor hearts also makes artificial hearts a potentially lifesaving option for some patients who now must wait as long as a year to get a transplant.
Reflecting on an epidemic of heart failure, the National Academy of Sciences' Institute of Medicine, a quasi-public think tank that advises the government, has reported that as many as 50,000 to 60,000 patients nationwide could benefit from a heart transplant.
The CardioWest is a descendant of the Jarvik-7, the infamous prototype implanted in 61-year-old dentist Barney Clark in 1982. Clark lived for 112 days. The second patient, William Schroeder, lived 18 months, despite strokes, infections and hemorrhages. The FDA shut down the experiment.
Afterward, the device foundered for years in academia. Eventually, entrepreneurs struggled to salvage the technology, with various versions that were implanted in about 450 patients.
"It's a very American story," says study co-author Marvin Slepian, SynCardia's CEO. "In the '60s, it was the man on the moon and the artificial heart. We got to the moon, but we never finished the artificial heart. This is an epidemic of heart failure."
Over the years, the device has been re-engineered to reduce bleeding, stroke and infection, says Slepian, who, like Copeland, has a stake in SynCardia.
The new study found that 71% of those who received the heart survived for a year, compared with 31% of past patients who did not get the artificial heart. One-year and five-year survival rates among patients who got the device as a bridge to transplant were 86% and 64%, respectively. Several patients suffered strokes and bleeding. A pump malfunction killed one patient 124 days after the implant. Seventeen patients suffered infections.
Despite its drawbacks, the heart represents "a triumph of medical technology helping patients in dire circumstances," the University of Utah's Dale Renlund comments in an editorial.
The Food and Drug Administration is now considering whether to allow the heart onto the market and under what conditions. On March 18, an FDA advisory committee recommended that the heart be implanted only in desperately ill patients at major transplant centers. The lone dissenter in the 10-to-1 vote, cardiologist Mitchell Krucoff of Duke University, says he cast his vote not to derail the device but to highlight his concern that the heart's checkered history makes its value difficult to evaluate.
"When you cut out the heart out, that's an irrevocable step," Krucoff says.
An Epidemic Of Heart Failure In Australia
While there is no national data on the number of Australians who are suffering from an epidemic of heart failure, extrapolation from overseas studies suggests that at least 300,000 Australians are affected, with 30,000 new cases diagnosed each year.
As the diagnosis is commonly missed in patients with mild heart failure, the actual numbers could be as high as twice these estimates. The recent Cardiac Awareness Survey and Evaluation (CASE) study detected two new cases of heart failure for every 100 patients aged ≥ 60 years presenting to their general practitioner.
Heart failure is a major burden on the community, due to the costs of care and the poor quality of life and premature death of affected people. The prevalence of heart failure is increasing because of the ageing of the population and the improved survival of people experiencing myocardial infarction and heart failure. Moreover, the increasing prevalence of overweight, obesity and diabetes is likely to accelerate the incidence of heart failure.3,6,7
Horowitz and Stewart described heart failure in older people as “the epidemic we had to have”. They argued that current strategies for reducing the risk of ischaemic heart disease are a means of postponing rather than preventing disease, and therapies that have led to increased survival rates after myocardial infarction and heart failure have produced more individuals with chronic heart disease.
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