"When it comes to heart disease, the No. 1 cause of death for both men and women, there are so many more options than ever before," says George Ruiz, M.D., medical director of the MedStar Heart Institute at MedStar Union Memorial. "It's changing the landscape for maintaining and improving heart health."

Thirty-five years ago, little could be done for someone having a heart attack. They'd be given morphine for pain and lidocaine to treat ventricular tachycardia (irregular heartbeat). Since 1967, when the first heart transplant took place, an average of 2,000 transplants take place each year. Despite promoting the value of being an organ donor, that number has remained steady for the last 20 years.


"The likelihood of heart failure increases with age," explains Ruiz, "and issues related to heart disease are the primary reason for hospital admittances. Transplants are the ultimate solution but the supply is flat. As boomers age, demand will go up. We could do better making people aware of the 'beauty of donation,' but it's only discussed when you get your driver's license or you are forced by a tragedy. Meanwhile, advances in treatment are making the biggest difference."

"In 1998/2000 the American Heart Association set a decade-long goal to reduce coronary heart disease and stroke and risk by 25 percent by 2010. We actually realized this goal by 2008 and have seen continued improvements in the reduction of deaths due to coronary heart disease and stroke," says Clyde Yancy, M.D., past president and spokesperson for AHA. "As of 2009, we have seen a near 40 percent reduction in death due to coronary artery disease since 1998/2000.

Bernard P. Dennis, AHA chairman of the board, says in the AHA 2015 annual report, "Our Strategic Plan and 2020 Impact Goal is focused on improving the health of all Americans by 20 percent by 2020 and reducing the impact of cardiovascular diseases and stroke by 20 percent by 2020."

To facilitate reaching its goal, the AHA is focusing on Life's Simple 7: don't smoke, increase your physical activity, eat a healthy diet, maintain a healthy body weight, and get control of your cholesterol, blood pressure and blood sugar. These contributed to already improving heart health, but they still need to be a focus for the future. For instance, about 80 million adults in the United States have high blood pressure, but nearly 20 percent don't know it. Uncontrolled high blood pressure raises the risk of stroke, heart attack or heart failure. It's sometimes called "the silent killer" because it has no symptoms.

Mauro Moscucci, M.D., chair of the Department of Medicine at Sinai Hospital and the director of the LifeBridge Health Cardiovascular Institute, describes himself as an interventional cardiologist who has focused his work and research interest on how to improve outcomes. "Health care is certainly better than it used to be. We have relatively new drugs like statins, used to prevent and reduce plaque build-up in our arteries. Stents allow blood to flow normally and, since they are inserted via the groin or the wrist artery, the procedure is minimally invasive. And even though it may not seem like it, changes in technology are helping us. One benefit is improving the connection between doctors and patients, so we can monitor them after they leave the hospital. Another is the development of new devices that can be implanted into the heart to improve heart function or to monitor patients with heart disease," Moscucci says.

Moscucci also believes personalized medical treatments such as pharmacogenomics will help us in the near future. This is relatively new area of study on how our genes, our genetic composition, affects a person's response to drugs. It combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be customized to a person's genetic makeup. He says that not every patient responds the same way; with genetic testing we can be more targeted.

"It's a brave new world with options that were imaginary 5-10 years ago," says Ruiz. "And the process has gotten a lot more complex."

More choices, more options

Some of those once-imaginary options are improving existing implements and procedures. Stents are mesh tubes placed in weakened or narrow arteries to improve blood flow. Now almost commonplace in treating heart disease, a new version is bioresorbable. Currently, 15 programs are in progress to test their efficacy, five in the advanced development stage. Because the stent disappears, it eliminates or reduces complications connected with their implantation. After two years, the blood vessel returns to its natural state, which means all options can be employed in the future if needed. One doctor called it a treatment game-changer and it is now in a nationwide clinical trial.

MEMS (MicroElectricMechnicalSensors), miniaturized elements, can be implanted on stents. Then the sensor can measure pressure in the heart and monitor what's happening. "A physician can set parameters for the heart's function; when they're exceeded the doctor is notified via a mobile phone allowing him to intervene and modify care. This also prevents hospital and emergency room re-admissions, something neither the patients nor doctors want." Moscucci explains.

Another solution is the Left Ventricular Assist Device (LVAD). Ruiz says it helps people get back to life.

A small pump is inserted into the heart and do its job, mimicking the heart's function. Once implanted, patients have a normal blood flow so their other organs come back to life.

Atrial Fibrillation (AFib) is described on the Centers for Disease Control (CDC) website as "the most common type of heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast or in an irregular way." It can be either episodic or permanent. The CDC says an estimated 2.7 to 6.1 million people in the United States have AFib and, with the aging of the U.S. population, this number is expected to increase. Most take a blood thinner such as warfarin, a pharmacologic solution. An alternative is the WATCHMAN Device that can be implanted in the heart. Over time, it may lower the risk of stroke and eliminate the use of warfarin.

Another device that is improving long-lasting persistent AFib is a wireless pacemaker inserted directly into the heart without surgery. It's inserted through a catheter threaded from a leg vein to the right ventricle of the heart. At 6-millimeters-by-42-millimeters, the new device is smaller than conventional pacemakers. All components are self-contained.


The crystal ball

Looking into the future, what does it hold?


"Now that we can replace valves without open heart surgery, it's not invasive, but" says Moscucci, "there are still risks, so the physician needs to ensure the procedure is appropriate, that it will benefit the patient. We doctors need to look at the patient as a whole person, not just a heart and do what makes the most sense. We should consider the quality of life and what benefit, if any, is gained."

Ruiz says much the same thing. "The patient has to ask himself, 'What's your goal?' Is it to live longer? Or is it to live well?' And then we have to ask 'How can we combine the medical and technical advances to provide better care to more people?' As with any stage of life, it requires thoughtfulness. But you have to think about if it's right for you. As attractive as the technology is, stay focused on the goals, not the means. And the medical community needs to provide alternatives just as much as other options – viable alternatives that meet those goals and needs."

Our life expectancy has increased so preventing cardiovascular disease will become even more important. In addition to all the new devices and procedures, there are changes in how we're cared for at hospitals. Ruiz has been instrumental in embedding a palliative care team to work with his advanced heart failure team. "We need to be thoughtful about how we deploy these technologies and about what best meets the patient's needs. Sometimes we need to offer the option of managing your symptoms and keeping you comfortable while improving your quality of life," Ruiz says.

So it's up to us. Just because we have access to a myriad of treatments, we need to work with our doctors for the best outcomes. And since doctors are paid a fee for service, for what they do, they don't always have to time to just talk and discuss all our options. We have to take some of the responsibility.

Meanwhile, what can we do to improve our health? Start with Life's Simple 7 from AHA. Increasing our physical activity is probably the easiest and provides the most benefit. Research shows that moderate-intensity physical activity, like walking around the block, can be accumulated throughout the day in 10-minute bouts and it's as effective as exercising for 30 minutes straight. Set aside time each day, even if you have to add it to your schedule. Extra reasons to get moving? You'll boost your creative thinking and mental acuity, it will improve your mood and your quality of life as you age, and you'll probably lose weight – all good.

Next, work on your diet. If you can eliminate prepared foods, the source of most of the sodium we ingest, we can lower our blood pressure. You can make improving your diet fun by involving your children or grandchildren, teaching them to cook and sharing family recipes or even creating new ones.

We all get aches and pains. And the truth is we want to be healthy as long as we can. As the Wizard of Oz points out, our hearts are breakable. Take care of your heart and it will take care of you. •