Around 6,500 inpatients with a cardiac pumping insufficiency (heart failure) are treated at the Herz- und Diabeteszentrum NRW (HDZ NRW), Bad Oeynhausen, every year. Evidence has shown that heart failure is the most frequent individual inpatient diagnosis.
Most patients with this progressive disease have it for many years. Whereas drug therapy often brings considerable relief initially, many different treatments should be considered as the disease advances, depending on the patient and his or her clinical picture. In Bad Oeynhausen, a joint team from the Clinic for Thoracic and Cardiovascular Surgery (Director: Prof. Dr. Jan Gummert), the Clinic for General and Interventional Cardiology (Director: Prof. Dr. Volker Rudolph) and the Clinic for Electrophysiology/Rhythmology (Director: Prof. Dr. Philipp Sommer) guarantees that the most suitable treatment is found for every patient at each stage of the disease.
The Herz- und Diabeteszentrum NRW is a national center for the treatment of cardiac insufficiency which has been certified (HFU – Heart Failure Unit) by various specialist societies. "Chronic heart failure occurs more frequently with age", Professor Dr. Jan Gummert, Medical Director of the HDZ NRW, said. "But the risk in diabetics is two- to sixfold higher." Early treatment can be additionally complicated by the fact that symptoms can occur very late in some patients. "The causes of this disease and the course it takes can also vary enormously, making interdisciplinary exchange of expertise imperative in order to evaluate precisely the degree and extent of left- and/or right-heart failure, pulmonary hypertension or other concomitant diseases, and from this information to develop the best possible and gentlest treatment strategy for the individual patient." For this reason, intensive communication takes place in Bad Oeynhausen between cardiac specialists, other specialists and referring general practitioners. Regular further training is also offered, including live transmissions from operating rooms and cardiac catheter laboratories.
Three specialist clinics under one roof
The outpatient and inpatient care of patients at the new Heart Failure Center takes place in close interdisciplinary cooperation with the Clinic for General and Interventional Cardiology (Director: Prof. Dr. Volker Rudolph), the Clinic for Electrophysiology/Rhythmology (Director: Prof. Dr. Philipp Sommer) and the Clinic for Thoracic and Cardiovascular Surgery (Director: Prof. Dr. Jan Gummert). Joint teams, containing both Senior Physicians and nurses who have received extra training in this field, care for patients with severe heart failure on the neighboring ventricular assistance and heart transplant wards.
Quality of life despite complexity of disease
Since heart failure seldom occurs alone, and personal risk factors can affect the prognosis, additional specialists at the HDZ NRW, such as laboratory diagnosticians, diabetologists, radiologists and pneumologists, can become involved in the treatment process as required. Prof. Rudolph explained the strategy implemented at the HDZ as follows: "A multi-system disease requires a multi-disciplinary team. Initially, our main focus is always to detect the cause of heart failure and – whenever possible – eliminate it." This means: high blood pressure needs to be lowered, while coronary artery disease might require interventional treatment in a cardiac catheter laboratory, and valve disease might require surgery. "Patients with dysrhythmia or atrial fibrillation, on the other hand, can profit from medication, pacemaker implantation or catheter ablation, as well as from some special procedures we have established, such as catheter-based treatment of the heart valves." Other important elements of this concept are a differential diagnosis of the causes of right-heart failure, as well as the joint evaluation and guideline-compatible treatment of pulmonary hypertension.
Sometimes the contractility and pumping capacity of the heart can be improved using so-called cardiac resynchronization therapy (also known as biventricular pacemaker therapy). "Such pacemakers boost the contraction of the heart muscle in patients with cardiac failure and improve the coordination of the two ventricles", explained Prof. Sommer, who is specialized in particularly low-radiation interventions and who opened a new cardiac catheter laboratory at the HDZ NRW earlier this year.
Comprehensive telemedical care and monitoring has been available to HDZ patients with cardiac failure via the Institute for Applied Telemedicine (IFAT) for many years now. The Institute works closely with general practitioners and ambulatory cardiologists, and is equipped with all the latest relevant technology.
Research into the links between chronic heart failure and disturbed nightly sleeping and breathing patterns has a long tradition at the HDZ, which is home to the first ever cardiological sleep laboratory in Germany. More recent research projects at the Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, as well as the Agnes Wittenborg Institute for Translational Research at the HDZ NRW, are addressing various aspects of cardiogenetics, as well as the development of new approaches to drug therapy for heart failure. In 2018, a dedicated nursing focus on cardiac failure was initiated.
Prof. Gummert summarized the guiding principle of the experienced members of the Bad Oeynhausen heart failure team, who are also contact partners for self-help groups, as follows: "The highest priority of our joint treatment strategy is to achieve and maintain the best possible quality of life for our patients at every stage of their disease and in the long term." The heart failure center in Bad Oeynhausen covers the entire range of state-of-the-art treatment procedures, from early diagnosis to high-end medicine, with one of the most comprehensive artificial heart programs for patients with severe heart diseases in the world. As the largest heart transplant center in Europe, the HDZ NRW is also a source of hope to patients waiting for a new heart.
(Quellen: Herzbericht 2018, HDZ NRW)
Herz- und Diabeteszentrum Nordrhein-Westfalen
Universitätsklinik der Ruhr-Universität Bochum
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