Heart Disease and Heart Failure
Heart failure is an immense and growing medical problem in the US. It affects nearly 5 million people with approximately 500,000 new cases diagnosed each year. It is a progressive condition where the heart has been damaged by disease or injury and cannot pump enough blood and oxygen to meet the body’s needs. Health care costs associated with heart failure are estimated to be as high as $23 billion annually.
Steven Goldsmith, MD, is a national leader in heart failure research. He is the Medical Director of the Minnesota Heart Failure Consortium (MHFC) – a network of Minnesota researchers committed to advancing our understanding of heart failure and how to treat it. Dr. Goldsmith works closely with Bradley Bart, MD, a leading cardiologist and Hennepin County Medical Center physician.
Goldsmith and Bart are conducting translational research projects to try to reduce the impact of heart failure by developing new medicine and medical treatments that can be directly put to use by physicians to improve patient outcomes.
Many innovative strategies to improve heart function in heart failure patients have emerged in the past few years. However, patients have not benefited from these advances because large clinical trials have not been conducted to verify their effectiveness and safety in humans.
To address this, the National Institutes of Health has awarded Goldsmith and the MHFC a prestigious grant to conduct the clinical trials necessary to bring these new heart failure treatments to regular medical practice. They will work with the NIH and other research collaborators nationwide to determine what aspects of heart failure to study and then carry out investigations in several different areas of cardiac care. The research collaboration will continue for up to five years.
The MHFC will begin recruiting for four studies in 2008, CARRESS, RELAX, DOSE, SMMART. The CARRESS study and DOSE study will look at treatment strategies for patients with acute decompensated heart failure. Patients with this type of heart failure experience declining kidney function and need kidney dialysis, which further exacerbates their condition. In the CARRESS study, researchers will use an ultrafiltration technique developed at MMRF that helps preserve normal blood flow in the kidneys during dialysis, reducing the negative impacts of kidney dialysis on the body. The DOSE study will seek to find an optimal balance in diuretic dosing to remove excess build-up of fluid, while minimizing the negative affects of diuretics on kidney function.
The RELAX study will evaluate the use of sildenafil (Viagra) for patients with a specific type of heart failure that medical professionals refer to as heart failure with preserved left ventricular systolic function. This type of heart failure is most common in older patients and women. Currently there are no treatments for it. Sildenafil has properties that cause the muscle walls of blood vessels to relax and widen, which may help manage heart failure.
The SMMART study will explore the effectiveness of surgery on two types of heart failure - nonischemic cardiomyopathy and mitral regurgitation. No single procedure has been identified as best suited to treat these types of heart failure. Typically, patients undergo surgery on the failing heart tissue or begin non-surgical medical therapies. However, no randomized trials have been conducted to determine which approach is more effective. The SMMART trial will try to determine which course of treatment is more effective.
Visit the Minnesota Heart Failure Consurtium website.
