By Irving Zucker, Ph.D.
University of Nebraska Medical Center

Despite numerous advances in drug therapy and cardiac assist devices, the prognosis for chronic heart failure remains quite poor. The numbers are stunning - for the most severe cases, about 60 percent of patients with heart failure will be dead within one year.

The most common cause of heart failure is repeated or large heart attacks. These result from coronary artery disease blockage of the blood vessels supplying oxygen to the heart due to plaque build up.

Chronic, uncontrolled high blood pressure is another insidious cause of heart failure. In some cases, heart failure is caused by a virus attacking the heart, but in many cases we never know the exact cause. Chronic heart failure results in a debilitating disorder often resulting in hospitalization. In an attempt to compensate for poor cardiac function, the body retains fluid and constricts the small blood vessels supplying vital organs.

Years ago, patients with heart failure were advised to do as little work as possible, as we didn't really have good treatments. Today the care and managements of patients with heart failure has progressed to the point where many patients can be effectively treated and enjoy a good quality of life.

Unfortunately, there are still a large number of people who are debilitated by this disease to the point of becoming incapacitated. The key to success is to make the diagnosis early and get the best treatment for the heart failure.

At the University of Nebraska Medical Center, we are working hard to deal with the growing incidence of heart failure. Since last week was Heart Failure Awareness Week (Feb. 10-16), it's a good time to reflect on heart failure and what is being done to address this difficult problem - in the research lab as well as in the clinical and educational settings.

Scientists at UNMC are conducting research with the goal of discovering new therapies for heart failure. Some of the important research being done at the medical center includes:

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* nvestigating the mechanism by which the nervous system influences the cardiovascular system in chronic heart failure.

* studying how the diabetic heart behaves at a cellular level by looking at specific proteins that regulate the release and uptake of calcium in diabetes.

* looking at the role of abnormal kidney function in the development of hypertension.

On the clinical side, UNMC's hospital partner, The Nebraska Medical Center, is the only facility in Nebraska with a comprehensive advanced heart failure program. Our physicians are not only able to treat patients with medications, but also are able to perform heart transplantation and the implantation of support devices known as "left ventricular assist devices."

Some of the most sophisticated cardiovascular imaging techniques have been developed right here in Omaha. These new ultrasound techniques hold the promise for improved diagnosis and treatment using novel drug delivery strategies. Additionally, cardiac magnetic resonance imaging is giving us views of heart muscle disease that we could not visualize by any other technique.

At the present time, the main medical treatment for patients with heart failure is to administer drugs that block two main hormones that are elevated in heart failure and provide stress to the heart. For patients who develop arrhythmias - an irregular heart beat - devices can be implanted to resynchronize the heart to help it pump more efficiently.

Perhaps as important as any procedure for heart failure is the work done by our advanced heart failure management team. This team reduces admissions to the hospital through patient education and by fine tuning theirmedications.

Cardiovascular disease is one of the few maladies that can be altered by changes in life style. Certainly, the reduction in the incidence of coronary artery disease over the past two decades has come about because of an increased awareness of the influence of diet and exercise on our health.

The American Heart Association through research grants and UNMC through its support of basic and clinical research are working together to help the population of Nebraska live better and healthier lives.