Recent reports in the medical literature have called attention to the condition called diastolic heart failure - that is, heart failure that occurs without a weakening of the heart muscle - by pointing out that patients with this common syndrome have a risk of death almost as high as patients with "classic" (that is, systolic) heart failure.
This conclusion was reached by following the outcomes of thousands of patients who were admitted to the hospital with diagnoses of heart failure. Patients were classified according to whether their left ventricular ejection fractions were reduced (as they always are in patients with classic, systolic heart failure), or whether they were preserved in the normal range (indicating diastolic heart failure). The investigators came to the somewhat surprising conclusion that patients with diastolic heart failure had mortality rates that were not only substantially elevated, but also were nearly as high as for patients with the classic form of heart failure.
DrRich Comments:
Most doctors think of diastolic heart failure as being a relatively benign condition, at least as compared to classic, systolic heart failure. After all, in diastolic heart failure the heart muscle is not obviously weakened, as reflected by the fact that the ejection fraction is well-preserved. On the contrary, however, this recent evidence shows that diastolic heart failure - which accounts for about half of hospital admissions for heart failure - is likely just as lethal as the "normal" kind of heart failure, and thus needs to be treated with just as much alacrity by doctors.
Diastolic heart failure is most common in older patients, more often women, who are overweight and have hypertension, and who quite often are smokers. Their primary care doctors refer relatively few of these patients to cardiologists, probably because their heart muscle itself appears "normal," and doctors think this indicates a good prognosis. Unfortunately, because diastolic heart failure was only a poorly recognized condition until a few years ago, and thus has not been well studied, the optimal treatment of this condition has not been worked out. {p}Now that experts are taking diastolic heart failure very seriously, however, the pace of research aimed at finding effective ways to treat this condition is accelerating.
In the meantime, at the very least, patients with diastolic heart failure (or its precursor, diastolic dysfunction), should take every effort to reverse the risk factors that often contribute - hypertension, obesity, and smoking. They might also consider an evaluation at a cardiac center that has displayed an interest in systematically identifying adequate therapy for this condition.
Look here for a complete discussion of heart failure, its causes and treatment.
Sources:
Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med2006; 355:251-259.
Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med2006; 355:260-269.
Aurigemma GP. Diastolic heart failure - A common and lethal condition by any name. N Engl J Med2006; 355:308-310.
