Cardiomyopathy is dangerous. But today, heart disease is less deadly.


Heart disease remains America’s leading killer. But medical innovations have made cardiomyopathy, or “heart failure,” a dreaded disease.

Cardiomyopathy affects millions of Americans and is the leading cause of hospitalization for people over age 65 in the United States. Lieutenant in Pennsylvania. Gov. John Fetterman (D) suffered a stroke while campaigning for the U.S. Senate in May after his campaign revealed he had been diagnosed with cardiomyopathy.

Cardiomyopathy is caused by a weakening of the heart muscle and a slower heartbeat. As the heart loses strength, it often enlarges to compensate for the lack of compression. Clinicians often classify filling by “ejection fraction”—the percentage of blood the heart is able to push forward. An increasing number of Americans also have heart disease with a normal ejection fraction.

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Fetterman, 52, is a case study of what can happen if appropriate treatment is not provided or maintained. In 2017, he was diagnosed with “atrial fibrillation, irregular heart rhythms and reduced heart pumping” – a not uncommon early manifestation of cardiomyopathy – and given a treatment plan that included limiting salt intake, losing weight and exercising. , and research shows that drugs can make a big difference.

But Fetterman couldn’t follow the doctor’s treatment plan — not even seeing a cardiologist for regular consultations. After the stroke, doctors diagnosed him with cardiomyopathy and implanted a defibrillator to prevent a fatal heart rhythm.

After his stroke, Fetterman said, “Like many other men, I avoided going to the doctor even though I knew I wasn’t going to feel well. As a result, I almost died.”

I am a cardiologist. Patients like Fetterman explain why the doctor-patient conversation is important after a cardiomyopathy diagnosis. My goal is to explain the situation and create a trusting relationship, resulting in appropriate patient supervision. This means walking the fine line between conveying to the patient the seriousness of the diagnosis and avoiding the sense of death that many people feel when told they have heart disease.

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While I make sure my patients understand that they have a serious, life-threatening condition, I would add that many people with cardiomyopathy these days live long and happy lives.

Research shows that people live longer in part because of the abundance of new innovations. The most prominent are newer drugs called SGLT2 inhibitors. Originally developed to treat type 2 diabetes, they have also been found to prolong and improve life in heart failure patients; they also have minimal side effects and can be used in patients with heart disease with a reduced or normal ejection fraction.

Unfortunately, because these drugs are so new, the first SGLT2 inhibitor was approved by the Food and Drug Administration in 2020 for the treatment of heart failure—most patients who would benefit from them do not, and in some cases, many doctors, including cardiologists. , have yet to update their practices, but also because of the high co-payments and administrative burdens imposed on clinicians by insurance companies.

Many people are first diagnosed with cardiomyopathy when they experience difficulty breathing or swelling in their limbs due to excess fluid in the body. After diagnosis, many patients move into a stable phase, but staying in this phase takes work. To live a long and healthy life with cardiomyopathy, make lifestyle changes such as weight loss, salt restriction, and exercise, as well as regularly taking medications prescribed by your doctor.

Evidence shows that taking four main categories of drugs can add three to eight years to life, In addition to changing the lifestyle, the year is additional. These drug categories include: beta-blockers (drugs ending in “-olol” such as metoprolol), ACE inhibitors (which end in “-pril” such as lisinopril) or ARBs (those ending in “-artane” such as losartan) or the brand name drug Entresto, MRAs such as spironolactone and, finally, SGLT2 inhibitors (ending in “-flozin” such as empagliflozin and dapagliflozin). Clinicians must explain to patients both the many benefits and fewer risks of medications while giving patients a sense of agency and ownership.

“You’re the quarterback and we’re your offensive line, we’re going to cover you,” I tell people a lot.

Sometimes even the best efforts don’t work or only work for so long — and patients progress to advanced stages of heart failure that can lead to repeated hospitalizations, inability to tolerate low blood pressure medications, and, in some cases, heart failure. progressive damage to organs such as kidneys and lungs. Patients experience progressive shortness of breath, initially during exercise and even at rest.

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When this happens, doctors may recommend surgical treatment, such as a heart transplant or the implantation of mechanical pumps that are sewn into the patient’s heart to help pump blood throughout the body. Survival after a heart transplant averages 13 years, with many patients living more than twenty years. Mechanical pumps called left ventricular assist devices, or LVADs, have also come a long way and can add years to life.

Both heart transplants and LVADs carry significant risks: donor heart rejection, infections, and cancers can affect heart transplant recipients; and bleeding, infections, and stroke affect LVAD recipients. Because the risks often outweigh the benefits, many patients are not good candidates for this therapy. At this stage, patients may seek palliative care, which focuses on quality of life and comfort care rather than prolongation of life, but patients with heart failure can benefit from palliative care at any stage of the disease.

Because cardiomyopathy remains a complex and troublesome disease, every effort should be made to prevent heart failure in the first place. For most people, that means controlling blood pressure and diabetes, losing weight, and preventing other types of heart disease, including heart rhythms and heart attacks that can lead to heart damage.

But treatment for cardiomyopathy has turned it from a death sentence into a condition where many people can live better and longer lives than ever before. Given the advances in science and medicine, there is hope that this will become a dreaded diagnosis in the future. For this reason, it is very important for patients to get the right help in time.

Hyder J. Warraich is a cardiologist at Brigham and Women’s Hospital, VA Boston Health System and Harvard Medical School. Is she “The State of the Heart: Exploring the History, Science, and Future of Heart Disease and the newly published book “The Song of Our Scars: The Untold Story of Suffering.”

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