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Pump Holds Hope for Terminal Heart Patients

Artificial device improved survival rate in study, but expert cautions high cost may limit its use

WEDNESDAY, Nov. 14, 2001 (HealthDayNews) -- An artificial pump may prove to be a lifesaver for tens of thousands of terminally ill heart failure patients, researchers announced this week.

But because three out of every four patients in the study died within two years of undergoing expensive operations to install the pumps, it raises questions about how much a few more months of life are worth.

"You don't get much bang for your buck," said Dr. Eric J. Eichhorn, a professor of medicine at the University of Texas Southwestern Medical Center. He was not involved in the research. "This is not going to be the salvation of heart failure therapy."

But others are more hopeful. Buoyed by news of an improved survival rate among patients who would otherwise have died, the New England Journal of Medicine released the heart pump research on the Internet several days before the official publication date of Nov. 15.

At issue is the treatment of heart failure, which strikes 550,000 Americans each year. Heart attacks, congested arteries or other stresses can cause a heart to become weak or stiff. Over time, it then loses the ability to pump blood properly.

Ironically, improvements in cardiac treatment are actually leading to more cases of heart failure, Eichhorn said. "We're getting better at treating heart attacks, but the consequence is that more patients are surviving heart attacks and down the road developing heart failure."

Doctors typically treat heart failure patients with a variety of drugs. Doctors turn to heart transplants in some cases, especially for younger patients. But only about 3,000 donor hearts are available each year worldwide.

The heart pumps, known as left ventricular assist devices, have been commonly used as a "holdover" device to keep heart failure patients alive until they can get a transplant, said Dr. Walter Dembitsky, a San Diego heart surgeon and co-author of the new study.

The pump works by taking over the functions of the dysfunctional left side of the heart, Dembitsky said. The right side of the heart is then under less stress and, if all goes to plan, should work more efficiently.

While treating patients waiting for transplants, doctors noticed that the devices held up well. "We found that we could keep people on these pumps for longer and longer periods of time," Dembitsky said. As a result, researchers at Columbia University and other institutions decided to see how the pumps would work as a separate treatment.

The researchers studied 129 patients who were in the final stages of heart failure and not eligible for transplant surgery. Of those, 68 got a heart pump and 61 underwent traditional drug treatment.

After one year, 52 percent of those who got a heart pump were still alive, compared to 25 percent of those who got the drugs only. After two years, 23 percent of the heart pump patients were alive, compared to only 8 percent of the other patients.

Survival rates were particularly high among patients younger than 60, Dembitsky said.

Eichhorn, the University of Texas professor, said the heart pump is a promising device, but he cautioned that its costs are high and the positive news coverage of the study may raise false hope among patients. According to Dembitsky, surgery and treatment may cost an average of $170,000.

"If you were to apply this to all the patients with advanced heart failure out there, and there are hundreds of thousands, you would bankrupt the economy of the United States," Eichhorn said. "It's just not doable."

Dembitsky acknowledged the high cost, but pointed out that the heart pump patients reported an improved quality of life. He added that doctors initially had to struggle to get funding for heart and lung transplants, which are still rare.

"Death today is definitely cheaper than death tomorrow" in these cases, he said, adding that it is up to society to determine which is worth more in the long run.

What To Do

Learn more about heart failure by reading this Q&A from the Heart Failure Society of America.

See pictures of a heart pump device from the manufacturer, Thoratec Corp.

SOURCES: Interviews with Eric J. Eichhorn, M.D., professor of medicine, University of Texas Southwestern Medical Center, Dallas; Walter Dembitsky, M.D., heart surgeon and director, Mechanical Assist Program, Sharp Memorial Hospital, San Diego; Nov. 15, 2001, The New England Journal of Medicine
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