CPMC's Heart Failure & Transplantation Program

Direct Physician Access: 866-207-4417

Things Have Changed

Professors in medical school and graduate training taught us that CHF was a progressive end-of-life collection of maladies lasting about four years — and then the patient died. Treatment was not complex. It consisted of salt restriction, digitalis, diuretics and instructions to “go home and take it easy.” There were occasional hospital admissions to diurese a patient. Fortunately, most of these patients were elderly and expectations were not high.

ACE inhibitors, beta-blockers and antiarrhythmics improved the quality of life and prognosis for patients, but it wasn’t until the introduction of cyclosporine in the 1980’s that heart transplantation really changed people’s lives. By the mid-1990’s transplant recipients had a 10-year survival of greater than 50 percent. It is now recognized that heart transplantation is the best long-term treatment for selective patients with CHF, with three-year survival rates up to 80 percent. Organ donations are stagnant at 2100 hearts per year — which does not nearly approximate the need. Northern California is fortunate because California Transplant Donor Network, the organization California Pacific Medical Center uses for organ procurement, is the best in the country at providing us with many organs.

The bar is rising rapidly for caring for CHF patients. Earlier in this decade, automatic internal defibrillators reduced the incidence of sudden death in patients with severe heart failure. This afforded many patients a second chance and the opportunity for more definitive care. Now pacemaker ventricular resynchronization technology is improving heart function in patients with cardiomyopathy and more improvements in electrophysiology are coming.

A new horizon in the treatment of congestive heart failure is unfolding — the rise of mechanical assist devices. After 30 years of development, permanent mechanical hearts are becoming an integral part of the long-term treatment of congenital heart failure in many patients. We are on the cusp of seeing devices that change people’s lives dramatically. Late stage CHF patients who receive permanent cardiac support devices now have a 67 percent two-year survival. With these new medical advancements, the diagnosis of congestive heart failure need no longer be the final diagnosis in a patient’s life cycle.