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Management of End-Stage Heart Disease, by Eric Rose, Lynne Warner Stevenson, Rose
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As the number of patients with end-stage heart disease continues to rise, the need for broader, better management guidelines increases. Dr. Rose's practical new book fills that need. All of the standard, time-tested treatment methods -- as well as the most current, cutting-edge alternatives -- are comprehensively covered. You'll find medical therapies that utilize positive inotropic agents, adrenergic blocking agents, and other drugs; surgical options, such as revascularization and valve surgery; myocardial replacement therapies that restore function through ventricular assist devices, flow pumps, and artificial hearts; and myocardial enhancement therapies, including dynamic cardiomyoplasty and ventriculectomy. Sound advice on the economic consequences and future implications of ESHD help you to make the best choices for every patient
- Sales Rank: #4779216 in Books
- Published on: 1998-07-15
- Original language: English
- Number of items: 1
- Dimensions: 11.50" h x 9.00" w x 1.00" l,
- Binding: Hardcover
- 271 pages
From The New England Journal of Medicine
Cardiovascular disease remains the leading cause of death in the United States, accounting for approximately 40 percent of deaths annually. Although advances in the control of cardiovascular risk factors and improved treatments for acute myocardial infarction have reduced mortality for most forms of heart disease, the death rate from congestive heart failure is increasing. It is estimated that over 3.5 million people in the United States now have congestive heart failure and that 5.7 million will be affected by 2030. The incidence of heart failure increases with age, and congestive heart failure is now the leading cause of hospitalization among persons who are older than 65 years of age. Seventeen percent of patients with congestive heart failure are being cared for by cardiologists, 43 percent by internists, 29 percent by family practitioners, and 11 percent by other types of practitioners. Because of the high and increasing prevalence of congestive heart failure, it is important for a broad spectrum of physicians to be familiar with the symptoms and appropriate treatment of the condition.
Management of End-Stage Heart Disease serves the goal outlined by the editors in the preface, to "provide an overview of the nature and magnitude of the problem of end-stage heart disease and a comprehensive review of established and investigational therapies." The book has five major sections that cover the epidemiology and economics of heart failure and benchmarks for the assessment of therapy, medical therapies, conventional surgical approaches, cardiac transplantation and left ventricular assist devices, and novel surgical therapies such as ventriculectomy and dynamic cardiomyoplasty.
The first and last sections are most suited to cardiovascular specialists interested in heart transplantation and the management of congestive heart failure. The sections concerning medical therapy and standard surgical approaches are well written and appropriate in their breadth and depth. They will interest any physician caring for a patient who has congestive heart failure. Although the book is entitled Management of End-Stage Heart Disease, it clearly outlines management strategies for patients with less than end-stage disease.
The chapter by Francis, "Approach to the Patient with Severe Heart Failure," provides a seasoned and logical approach to the care of patients with congestive heart failure before and during hospitalization. Francis, like most of the other authors, has nearly two decades of experience in the management of heart failure. Young's chapter on adrenergic-blocking agents gives a valuable historical perspective and sets the stage for the use of newer beta-blocking drugs with partial alpha-adrenergic antagonism. The excellent chapters concerning the management of arrhythmias and the use of pacemakers in heart failure document the change in the paradigm for the treatment of arrhythmias in patients with cardiovascular disease, particularly those with heart failure. Mancini's chapter on the evaluation of exercise capacity in patients with heart failure is written primarily for specialists who must determine the functional capacity of and the potential outcome of heart transplantation in patients with end-stage disease. Her chapter is a state-of-the-art analysis of the components of diminished exercise capacity in patients with heart failure, including cardiac, pulmonary, and peripheral-muscle deficiencies. Stevenson provides a segue to the surgical components of the book in her analysis of the types of heart failure that require surgery.
Chapters concerning conventional surgical options for the management of heart failure are driven more by experience than data. Pagani and Bolling provide an excellent assessment of the risks and benefits of valve replacement in patients with ventricular compromise. The section on myocardial replacement, particularly transplantation, is most valuable in addressing the societal need to evaluate the cost and benefits of replacement therapies. The chapter concerning left ventricular assist devices provides an excellent overview of the sometimes confusing modes of heart support, including extracorporeal centrifugal, extracorporeal pulsatile, and implantable devices. The remainder of the surgical chapters, concerning artificial hearts and axial flow pumps, and the section on myocardial-enhancement therapies will be of benefit and interest only to specialists.
The editors, a cardiac surgeon and a cardiologist working in the area of heart failure and transplantation, have assembled authors to address not only the medical and surgical management of heart failure, but also the epidemiology and economics of this condition. The book documents the progress in this exciting area and should be read by all physicians training or practicing in the sub-subspecialty of heart failure and heart transplantation. The work will be of greatest value to the internists and generalists who care for the vast majority of patients with heart failure and who may have limited time to assimilate the wealth of available information in this rapidly changing field.
The book has three limitations, two of which reflect my bias and that of the editors. First, many chapters appear to reflect Stevenson's approach of tailored medical therapy, which mandates right-heart catheterization and the use of intravenous agents in patients with heart failure to optimize hemodynamics. Although this approach is novel, it has not yet been proved to be of greater benefit than standard approaches for hospitalized patients. Second, the book does not discuss the utility of endomyocardial biopsy in patients with congestive heart failure. Finally, the text has not been heavily edited, and many of the introductory sections are the same in various chapters.
It is evident from this book that the area of heart failure and transplantation has great potential for development as molecular and engineering advances are combined. The rate of advancement in this area will be limited only by issues of health care economics. Management of End-Stage Heart Disease appropriately summarizes our knowledge in the field to date.
Reviewed by Kenneth L. Baughman, M.D.
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