Death calculator: Predicting heart failure

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LOS ANGELES, Calif. (Ivanhoe Newswire) – Elijah Ali and his son Rafee share a love for healthy eating and sports.

“[We] love to walk, love to run, play ball, [and] sports,” Ali told Ivanhoe.

“I get all my game from my dad,” Rafee told Ivanhoe. “He was the first one to put the ball in my hand when I was a little boy.”

However, despite his active and healthy lifestyle, Ali developed heart failure at age 43 after a virus attacked his body.

“I was really shocked, and really dismayed,” Ali explained.

Today Ali and his doctor are using a new app that calculates his risk of dying in the next five years.

UCLA researchers developed the app based on four variables: BNP level (which measures fluid retention), medication information, the New York Heart Association Classification (which measures shortness of breath caused by physical activity), and peak oxygen consumption (which measures the use of oxygen by the heart).

“We can develop a score that helps us predict a patient that will do well or is not going to do well,” Martin Cadeiras, MD, Transplant Cardiologist, UCLA, told Ivanhoe.

The app shows the probability of survival. Ali has over a 90 percent chance of surviving one year and nearly a 70 percent chance of surviving five years. This data helps doctors tailor treatments and advice.

“Basically, it just lets you know where you are and where you don’t want to be,” Ali explained.

BACKGROUND: Heart failure, despite its name, is not when the heart stops beating all together. Rather it means your heart has stopped pumping enough blood to adequately supply your body. The heart’s inability to provide the body with sufficient blood causes it to expand and grow larger in order to hold more blood. Eventually this will wear out the heart, making it even less efficient. Heart failure also causes blood to congest in other parts of the body, like the lungs and vessels. It can also cause other tissue to hold onto fluid. Often this will be in the legs, abdomen, or liver. This “backing up” is why heart failure is often called congestive heart failure. (Source: CKf394Pho7wCFTJp7AodkhsAzQ)

CAUSES: Many conditions can lead to heart failure, including the following:

• Coronary Artery Disease: When plaque builds up in the arteries, less blood can reach the heart, causing it to work harder.

• Heart attack: heart attacks can essentially kill parts of the heart muscle which were starved of oxygen, making the heart work more to compensate for the lost muscle.

• Severe lung disease: if the lung’s ability to provide enough oxygen to the body is impaired, the heart has to compensate by pumping more blood.


NEW TECHNOLOGY: Although they have been around for years, doctors at the University of Pennsylvania are now using left ventricular assist devices (LVAD) in a different way, as a bridge-to-recovery following heart failure or other cardiovascular conditions. As the heart enlarges in order to compensate for injury, the LVAD assists with its blood pumping duties, taking some of the stress off of the heart. The heart slowly regains its strength, and the LVAD system is slowly dialed back as the heart returns to normal functioning, which usually takes between six and nine months. Already in use in Europe, the LVAD bridge-to-recovery has shown 90 percent of patients had no recurrence of their heart failure after two years. (Source:

Martin Cadeiras, MD, Transplant Cardiologist at UCLA, talks about a new way for doctors to use iPhones to detect at-risk heart patients.

How many people are affected by heart disease?

Dr. Cadeiras: Heart disease is the first cause of death in the population. And among those patients with heart disease, congestive heart failure is the common end; about 6 million people in the United States have congestive heart failure.

Has there been anything out there that could tell you what the risk is of these people with severe heart disease of dying?

Dr. Cadeiras: Well, there are tools that are available, however science is always evolving in order to try to improve these tools. What has been developed is a tool specific to the population that has end-stage heart failure, which is the population that is referred for heart transplantation or mechanical heart pumps. In whom we can develop a score that can help us predict if the patient is going to do well or is not going to do well.

And why is that important to you?

Dr. Cadeiras: This is important for multiple reasons. It’s important for the patient and it’s important for the physician. For the patient, because the patient wants to know ‘where am I today? Where I am right now in my disease course? Am I going to die tomorrow? Am I going to die in a year? In 10 years?’ It is important for them to be able to make the best decision for themselves. For the clinician as well. In the academic medical centers, let’s say like at UCLA, we use these tools to decide if the patient is currently too well to require a transplant or if it is the moment to move towards going to a transplant or a mechanical heart pump. We don’t want to be there too late because we know that this is not good for the patient.

What is the mortality rate for those diagnosed with heart failure within like five years?

Dr. Cadeiras: Yes, so, it is estimated and it varies, but about 50% of the patients will not be doing well after 5 years when they are diagnosed with heart failure. We have the ability to improve their therapies and we have to do that as much as we can with medicines; we have devices, we have lifestyle changes that we can work very close with patients in order to minimize that risk.

How does the heart failure risk calculator work? It’s based on four variables?

Dr. Cadeiras: Yeah, that’s one of the key things. This is a calculator that has been developed by researchers here at UCLA led by Dr. Tamara Horwich and we have actually worked then with our students in order to put that in the form of a tool that we can all have in our IPhones as an app.

How does it work?

Dr. Cadeiras: So the score basically uses four variables. There is one variable that is a measure of the amount of fluid or how the fluid is straining inside the heart; that’s called BNP or B-natriuretic peptide.

Wait, heart disease is all about too much fluid?

Dr. Cadeiras: Heart failure is much about fluid. It’s the heart not being able to pump well; it’s too weak, so fluid backs up, for example to the lung or to the circulation and then accumulates inside the body.

What’s the next variable?

Dr. Cadeiras: The other variable that is included in this score is whether the patient is on a specific medication. This medication is called an ACE inhibitor or an angiotensin receptor blocker. The fact that the patient is on that medication is good because it is linked to patients doing better over time; the fact that the patient is not on that may be an indicator that the patient is worsening or is doing poorly. The third variable is what we call New York Heart Association functional class that basically grades the severity of shortness of breath. Patients with heart failure have shortness of breath which is a manifestation of fluid that backs up to the lungs and the more shortness of breath that a patient has, the higher that score. The fourth variable is a little bit more complex to explain, but it’s basically related to how we perform doing exercise. An analogy can be when we get our car to measure the gas every year or every so often to see how the engine is working, so the emissions in the car are way of judging how our car is doing in general. And in the body is about the same. How well our heart is performing we can measure with a special machine connected to a mask and the result of that evaluation we plug it into the app as well. This is called cardiopulmonary exercise test and the result of that test is the fourth variable of this score.

How long does it take to do all four variables?

Dr. Cadeiras: Just two minutes. Basically we can just plug it in our phone. The BNP is a variable that we have from the laboratory.

Does that come from a blood test?

Dr. Cadeiras: Yes the BNP is a blood test, so we obtain that at the clinic visit. The presence of this medication called ACE inhibitor or angiotensin receptor blocker is the fact that the patient, has it or does not have it. The functional test, the patient test, which is the exercise tolerance that is too low or too high and that goes from one to four and then we find that third variable. And the fourth is a test that we take in our clinic and will give us a number that usually is between, in this population, around 10 to 20.

Is that the breath test?

Dr. Cadeiras: That is the cardiopulmonary exercise test. So the fourth variable is the result of the cardiopulmonary exercise test which we get in our clinic.

What do patients do for that?

Dr. Cadeiras: The patients are told to exercise on a bicycle connected with a mask and through that mask the gas exchange with respiration is measured. Those specific measures are turned into a score and that score is the one that we plug into the application.

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.