Device Plus ‘Aggressive’ Drug Strategy May Curb Severe Heart Failure

A combination of an implanted heart device and intensive drug therapy may help boost heart function in end-stage heart failure patients, preliminary results of an ongoing study suggest.

The research focused on 36 patients who were implanted with what’s known as a left ventricular assist device (LVAD), a kind of heart pump.

“Patients who receive this assist device generally are in line to receive a heart transplant,” explained cardiologist Dr. Michael Kim, who reviewed the new findings.

“Because there are not nearly enough hearts available for transplantation relative to the need for heart transplantation, these newer assist devices can keep these sick patients alive until a heart does become available, sometimes for years,” said Kim. He directs interventional cardiology at Lenox Hill Hospital in New York City.

The new study was led by Dr. Emma Birks, professor of medicine at the University of Louisville. Besides receiving the LVAD, patients in the study were also prescribed an aggressive regimen of five different drugs: lisinopril (Prinivil); spironolactone (Aldactone); digoxin (Lanoxin); losartan (Cozaar); and carvedilol (Coreg).

With this combined therapy, 13 (nearly one-third) of the patients recovered enough heart function after an average of 344 days to have the LVAD pump removed, the researchers said. Two patients who still had pumps received needed heart transplants, and one who still had a pump died, according to the report.

The 20 other patients still have their pumps, but two are scheduled to have their devices removed, the study authors said. The findings were scheduled for presentation Sunday at the American Heart Association’s annual meeting, in New Orleans.

The results suggest “that even very advanced heart failure can be reversed using these heart pumps, particularly when combined with additional drug therapy, avoiding the need for heart transplantation for these patients and making the donor heart available for another needy individual,” Birks said in a heart association news release.

“The fact that this could be done in several centers suggests that using the device with this drug combination to reverse heart failure is possible on a larger scale,” she added. “It has previously been thought that these devices rarely recover heart function enough to allow them to be removed, but this study suggests that this can occur in a much bigger number than originally thought, particularly if combined with drug therapy.”

Kim was encouraged by the findings, but stressed that the study was small and “more follow-up is needed to confirm this observation.” Experts also note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Dr. David Friedman is chief of congestive heart failure services at North Shore-LIJ’s Franklin Hospital in Valley Stream, N.Y. He called the study “very positive preliminary research,” which shows that “strategies used to help advanced heart failure patients definitely help to try to have patients get improved overall clinical outcomes and better quality of life going forward.”

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart failure.

Source: HealthDay