How to manage the rising epidemic of heart disease

Click to listen to Dr. Samer Najjar’s podcast on heart failure.

Heart disease is the leading cause of death for both men and women in the United States.

While heart attacks and strokes get much of the attention when it comes to heart-related conditions, there is another common killer: congestive heart failure.

In fact, recent statistics indicate that more than five million Americans are living with congestive heart failure (CHF), and nearly 550,000 new cases are diagnosed each year.

Unfortunately, many people aren’t even aware that they are living with this very deadly disease.

"The difficult thing about heart failure is that it doesn’t have just one way that it presents itself,” says Samer Najjar, MD, director of the Advanced Heart Failure Program at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center. “With heart attacks and strokes, when you have symptoms, you have to go to the hospital very early because there are things that can be done. The longer you wait, the more injury can happen. Heart failure is different. There is a myriad of different types of symptoms people can have, which makes it harder to distinguish who has heart failure and who does not."

Once a patient has been diagnosed with heart failure, Dr. Najjar explains it’s quite likely he or she will need to continue treatment for a lifetime. “This is not just a condition of something happened and you ended up in the hospital, we treat you and you go home and it’s over with. Not at all. Heart failure is something people live with for the rest of their lives.”

Signs & Symptoms

Common symptoms of CHF include swelling of the legs, shortness of breath, lethargy, loss of appetite and abdominal pain.

Dr. Najjar explains there are two different types of heart failure. In one form, the heart is trying to pump but the muscle is too weak to do so efficiently. “If the muscle is weak, it’s having a hard time pumping the blood forward. Therefore, the blood will back up. It will back up into the lungs which is what causes shortness of breath and then it backs up into the rest of the body and that’s how patients start retaining fluid.”

The other form of heart failure, known as preserved ejection fraction, can be deceiving, because despite the fact that the heart appears to be squeezing normally, it’s having difficulty getting blood to the rest of the body. “That’s something that we in the medical field have struggled with for some time, because it’s not immediately obvious to us,” says Dr. Najjar.

Risk Factors

Anything that can cause injury to the heart puts people at risk for having heart failure. For example, high blood pressure, high cholesterol, high blood sugar, previous heart attack(s), smoking–all of these can contribute.

However, approximately 30 to 40 percent of those with heart failure have no discernible risk factors.

Still, Dr. Najjar is quick to emphasize that while some cases seem to appear out of nowhere, “there are known risk factors, which is why these risk factors have to be addressed during one’s lifetime.”

There are also lifestyle choices that are very important. “Exercise is a huge risk factor modifier and our population needs to do much more physical activity and exercise than what is common.”

Treatment Options

Advancements in medical science have provided a variety of treatment options, including oral medications.

“There are a lot of medications that have been studied, and several have been shown without any doubt that they actually improve survival. People live longer and feel better,” says Dr. Najjar. With these medications, it’s important for patients to keep close contact with their doctors until the correct dosage has been determined.

Other treatment options include devices such as pacemakers and defibrillators.

And, there are steps patients need to take to ensure these treatments remain viable. For example, salt is a huge culprit in terms of fluid retention. Patients also need to monitor how much fluid they take in on a daily basis. Consistent weigh-ins can be helpful to monitor fluid retention and identify a problem prior to the appearance of any other symptoms.

Life-Long Care

Once a patient has heart failure, Dr. Najjar explains it’s quite likely he or she will need to continue treatment for a lifetime.

The crucial thing to remember is that you cannot ignore risk factors. “You don’t want to wait until you have a problem, either a heart attack or heart failure,” says Dr. Najjar. “You have to be able to modify those risk factors in middle age, in young age, as soon as you find out that they happen, because when you’ve already developed the disease, you’ve already lost the opportunity to prevent them.”

Click to listen to Dr. Najjar’s full podcast on heart failure.

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A Belated Valentine to the Nation’s Capital: Our New Heart & Vascular Hospital Opens

More than 300 donors, former patients, healthcare staff, elected officials, and guests gathered at MedStar Washington Hospital Center on June 16 to witness the dedication of the Nancy and Harold Zirkin Heart & Vascular Hospital, the first dedicated cardiovascular hospital located in the greater Washington, D.C. area. The occasion marked the end of years of planning, design and construction, as well as the beginning of a new era of tightly coordinated, centralized specialty care for the most complex cardiovascular cases in the region.

“This is an extraordinary milestone for our patients,” said Stuart F. Seides, MD, physician executive director of MedStar Heart & Vascular Institute. “Every aspect of the new hospital was designed with patients’ comfort, convenience and safety in mind as we worked to create an environment conducive to healing.”

About the Nancy and Harold Zirkin Heart & Vascular Hospital

The new four-story, 160,000 square-foot, state-of-the-art facility unites virtually the entire heart and vascular healthcare delivery staff—cardiologists, cardiac and vascular surgeons, nurse practitioners, cardiac care nurses, and other specialized caregivers—into one cohesive team in one location, for more effective, streamlined care.

“Previously, patients with heart problems could have received care on one of 10 different nursing units,” says Allen J. Taylor, MD, FACC, FAHA, chief of Cardiology at both MedStar Washington Hospital Center and MedStar Georgetown University Hospital. “This new configuration eliminates variability in care, while fostering communication and collaboration among team members.”

Adds Nancy Bruce, RN, BSN, MBA, assistant vice president for Nursing, “It also makes it possible for us to ensure that the patient/family experience is seamless, and care is coordinated every step of the way.”

From admission to discharge, all aspects of the new hospital-within-a-hospital help promote that goal. Patients are now housed according to condition, treatment and acuity of care, leading to increased proficiency and teamwork for staff members accustomed to caring for patients with diverse heart and vascular diagnoses. Patient floors feature their own echocardiography, X-ray and other non-invasive services for faster, more convenient examinations and evaluations. Stress testing is done on the first floor of the new space. The majority of the 164 patient rooms are also private, furnished with couches and other amenities, to increase the comfort and satisfaction levels of patients and their families.

An Expanded Cardiac Critical Care Unit

July found the opening of the last phase of the project, an expanded 44-bed cardiac critical care unit (CVICU) that combines the functions of the previous three units into one: recovery room, coronary care unit and cardiovascular surgery ICU. A unique feature is a central boom suspended from the ceiling, for medical gasses, electrical and data outlets. By doing away with the old wall mounts, the design gives staff unfettered 360-degree patient access.

“The new, cutting-edge ICU will allow surgeons, intensive care physicians, nurses, and mid-level practitioners to constantly improve care, comfort and efficiency for the sickest patients in the region,” says Paul Corso, MD, chairman, Cardiac Surgery. “The unit is structured for ever-expanding, high-tech monitoring and communication among caregivers, patients and families. Cardiovascular surgery will continue to innovate and add new procedures because of the capabilities of the new ICU. The new Zirkin Heart & Vascular Hospital is the culmination of a dream for cardiovascular care in the mid-Atlantic region.”

Turning a Dream Into Reality

MedStar Washington Hospital Center is one of the busiest cardiac surgical centers in the United States and is nationally recognized for excellence in cardiovascular care. MedStar Heart & Vascular Institute, founded at MedStar Washington Hospital Center, is engaged in a clinical and research alliance with the world-renowned Cleveland Clinic Sydell and Arnold Miller Family Heart & Vascular Institute to improve patient outcomes and operational excellence.   

With the opening of the dedicated heart and vascular hospital, the patient and family experience now matches the hospital’s reputation for outstanding clinical expertise. Thanks go to Nancy and Harold Zirkin and their $10 million leadership gift. “When Nancy and I learned about the vision of MedStar Heart & Vascular Institute and its important alliance with Cleveland Clinic,” Mr. Zirkin says, “we saw this as an ideal opportunity to bring together our strong interest in better health with the region’s need for world-class heart care. We’re thrilled we were able to help make MVHI’s dream a reality.”

Dr. Seides concludes, “We’ve always been blessed with some of the most talented and dedicated physicians and nurses in the country. Now we are providing them with an environment that allows that teamwork to flourish--and ultimately allows us to provide the best possible patient care.”

Have questions?

We are here to help! If you have any questions about MedStar Washington Hospital Center, call us at 855-546-1974.

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Walk with a Doc – A Doctor’s Perspective

As I turned in bed, the crispness in the air and pitter-patter of tiny droplets of rain on my bedroom windows aroused me from my nights slumber. I thought to myself, “What time is it? I have to get up?” The morning had finally arrived. Most Saturday mornings like this when I am not on-call, I toss and turn much longer, to make up my sleep deficit from the previous week. But not this day, I had to be at the National Arboretum before 9 a.m., to take part in a new community initiative at MedStar Washington Hospital Center called, “Walk with a Doc.”

“Walk with a Doc” is a national health and wellness campaign created to improve the connection between community members and health providers. My colleague, Dr. Patricia Davidson, a cardiologist and internist and I would lead each session, allow walkers to ask questions and make new friends. I was delighted to engage with the community this way, and take my message beyond the walls of exam rooms.

Exercise and Cardiovascular Health

A wealth of evidence has demonstrated that participating in regular physical activity like brisk walking is associated with lower rates of cardiovascular disease, stroke, diabetes, obesity, and certain forms of cancer. In addition, increasing physical activity can improve mental health and memory, contributing to an overall sense of well-being.

Cardiovascular disease and stroke are the first and fifth most common causes of death in the United States. Even worse than death for some, stroke is the major cause of disability for adults. Therefore, the health burden for these two diseases combined is enormous. The sad part is that both are preventable. As the associate medical director for the Comprehensive Stroke Center at the Hospital Center, I have seen first-hand the devastation of stroke: lost lives, lost income, widowed family members, orphaned children, and work undone. So, I had to be at this inaugural event on time, despite the rain.

Taking Steps toward Better Health

When I arrived on site, colleagues from the Community Relations Department were already in place as well as ten to 12 community members. Briefly, I spoke about the cardiovascular benefits and other health benefits of moderate exercise. We began our one-mile walk around the beautifully landscaped area of the Arboretum. Two groups of walkers naturally formed based on the pace of each group. After the walk, Dr. Davidson spoke to the group and answered questions that were generated during the walk. Most participants were trying to gain a better understanding of the benefits of walking. Dr. Davidson shared how walking improved a person’s cardiovascular, health, cognitive health and could decrease the risk for stroke. The walkers were committed to improving their overall health. It was a congenial group and I met some great people from the community. An opportunity to get outside and get going with a group of like-minded people is the sole purpose of the program. I look forward to next week, same place same time, as we lace up our walking shoes and “walk with a doc” towards better health.

The Walk with a Doc event takes place on the first Saturday of every month, rain or shine, starting at 9 a.m. at the National Arboretum, located at 3501 New York Avenue, NE, Washington, D.C. 20002. The event is free and no registration is required.  Just put on a pair of comfortable shoes and meet us at the park!

For more information, visit www.medstarwashington.org/community

Have any questions?

We are here to help! If you have any questions about the Walk with a Doc or other community relations programs email MedStar Washington Hospital Center at [email protected]

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