PhotoYou hear a lot about the rising cost of health care and, at the moment, continuing debate over whether Obamacare will bankrupt the nation or cause the sun to go dark.

What you don't hear much about is how many potentially fatal diseases often go untreated or under-treated. Case in point: heart failure.

A new study from the Karolinska Institute in Sweden finds that patients with heart failure have a high mortality rate and are often undertreated, with often fatal reults.

According to the study, published in the scientific periodical JACC, many of these patients would benefit from advanced treatment by heart specialists -- something that could be decided by a simple evaluation of five common risk factors for early death due to heart failure.

"Currently, less than 5% of patients with heart failure receive heart failure pacemakers and many fewer receive heart pumps or transplantation. Our findings suggest that many more need these treatments and should be referred to heart failure specialists for evaluation," said study leader Dr Lars H. Lund of the Karolinska Institute.

10% of elderly

Lars Lund (Photo: Stefan Zimmerman)

Heart failure affects 2%-3% of the overall population and over 10% of the elderly worldwide, and is associated with high risk for early death and reduced quality of life. Drug therapy improves symptoms and reduces mortality and is well used.

However, modern pacemakers, heart pumps and heart transplant operations are of great benefit in selected patients, but are poorly utilized. Earlier studies have shown that a major reason is that heart failure patients are generally cared for by generalist doctors -- like family practitioners and internists -- with limited awareness of these treatments.

In the study, researchers analyzed data from 10,000 patients from the large Swedish Heart Failure Registry. First, the researchers showed that early death in these patients was related to heart failure rather than other causes, suggesting that better treatment for heart failure would reduce mortality.

Second, the researchers defined risk factors for mortality:

  • poor pump capacity,
  • poor kidney function,
  • low blood count, and
  • lack of treatment with ACE inhibitors and beta blockers.

If any one of these risk factors was present in a given patient, the mortality was so high that the patient would have potentially benefited from a heart pacemaker, heart pump and heart transplantation.

What to do

The lesson for consumers and their families: always seek an opinion from a specialist for any life-threatening disease or condition. They are better able to diagnose and treat such conditions and often have access to drugs and technologies not generally used by general practitioners.

Nearly all family physicians will refer patients to specialists when appropriate. Patients and their families should ask for referrals if the physician does not volunteer them.  

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