Heart Failure Treatment Choices

The NP Associates newsletter for February contains an informative article on Heart Failure and on possible treatments for the condition. According to Jennifer Cervino, MHS, PA-C, the author of the article 5 million people in the United States have heart failure and 550,000 will be diagnosed with HF this year alone. HF accounts for 15 million office visits and 6.5 million hospital visits each year for patients 65 and over. Hypervolemia is the contributing factor to HF. This leads to high re-hospitalization rates and increased health care costs. Diuretic drugs are the normal component of treatment plans. While the diuretics work at controlling the congestive systems, adaptations and resistances to the drugs normally develop as the disease progresses. In light of this, new therapies are being developed to better treat HF patients. One just technique is mechanical ultrafiltration or UF.

Ultrafiltration and Diuretics: Mechanical ultrafiltration has been used for more than 50 years in patients with end-stage renal disease requiring hemodialysis. Only within the last 25 years has UF been used and considered for HF patients who are diuretic resistant. During ultrafiltration, often called aquapheresis, blood is withdrawn from a patient with volume overload and then passed through semipermeable membrane (a hemofilter). The filter removes all the excess salt and water and then returns the blood back to the patient. UF can remove as much as 500 mL of fluid per hour. Because the extracellular fluid being removed is isotonic with the blood, serum electrolyte balance is maintained as sodium is removed.

Diuretics: Benefits, Limitations: Despite this data, the American College of Cardiology and the American Heart Association still use diuretics as the diagnosis of choice for HF patients. Diuretics are the cheaper and more readily available form of treatment for HF. There are obvious downsides to diuretics as well. Their use can actually do more harm than good if the proper care to replace key nutrients such as potassium to the body is not noted. Patients can see an increase of fluid retention which would complicated their HF problems. This problems seemed tied to  worsening renal function, prolonged length of hospital stay and increased long-term morbidity and mortality in addition to the other problems associated with HF and the use of diuretics.

Ultrafiltration: An Alternative?: The Acute Decompensated Heart Failure National Registry performed a study that looked at patients that have been hospitalized for HF and discovered that their treatments of diuretics was not solving the problem. Following that study, trials for UF have been performed. The RAPID-CHF trial showed that after 24 hours significant advances had been made to patients with decompensated HF and diuretic resistance. They had better results at a shorter interval then their normally prescribed diuretic therapy. The UNLOAD trial also concluded with results that reflected a safe and more effective way of fighting HF with the use of UF.

Questions Remain: As the use of UF is still relatively new in the field of HF and diuretic resistance patients there are still parts of UF therapy that is unknown. In addition the knowledge and understanding of UF is still not part of the main stream HF solution. One of the major inhibitors is the economic factors associated with using UF to treat HF.

For more information and the full article follow the link provided.
http://bit.ly/15jkPuN
Written by Brandon Kassof