Cardiomyopathy is scary. But today, the heart disease is less deadly.


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Heart disease remains America’s leading killer. But medical innovations have made cardiomyopathy, a.k.a. the scary-sounding condition “heart failure,” less of a threat.

Cardiomyopathy affects millions of Americans and is the leading cause of hospital admissions for those over 65 in the United States. When Pennsylvania Lt. Gov. John Fetterman (D) suffered a stroke during his campaign for the U.S. Senate in May, his campaign revealed that he had been diagnosed with cardiomyopathy.

Cardiomyopathy results from a weakening of the heart muscle that causes the heart to beat less vigorously. As the heart loses strength, it often enlarges to compensate for its lack of squeeze. Clinicians frequently classify the contractions by “ejection fraction” — the percentage of blood the heart is able to squeeze forward. An increasing number of Americans also have heart failure with a normal ejection fraction.

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Fetterman, 52, is a case study of what can happen if appropriate treatment is not provided or followed. He was diagnosed with “atrial fibrillation, an irregular heart rhythm, along with a decreased heart pump” in 2017 — not an uncommon initial presentation of cardiomyopathy — and given a treatment plan that included lifestyle changes, such as restricting salt intake, losing weight and exercising, and medications that studies show can make a big difference.

But Fetterman failed to follow his doctor’s treatment plan — not even going back to the cardiologist for regular consultations. After his stroke, doctors revealed his cardiomyopathy diagnosis and implanted a defibrillator to prevent a lethal heart rhythm.

As Fetterman put it after his stroke: “Like so many others, and so many men, in particular, I avoided going to the doctor, even though I knew I didn’t feel well. As a result, I almost died.”

I am a heart failure specialist. Patients like Fetterman are why the conversation between doctor and patient after a cardiomyopathy diagnosis is critical. My goal is both to explain the condition and establish a trusting relationship that will result in the patient embracing appropriate follow-up. This can mean walking a fine line between conveying the seriousness of the diagnosis to a patient and avoiding a sense of doom, which many people will feel when told they have heart failure.

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Although I make sure my patients understand they have a serious, life-threatening condition, I add that, these days, many people with cardiomyopathy live long, fulfilling lives.

Studies suggest people are living longer in part because of a plethora of new innovations. The most notable are new medications called SGLT2 inhibitors. Initially developed to treat Type 2 diabetes, they also were found to prolong and improve the lives of patients with heart failure; they also have minimal side effects and can be used for heart failure patients with both reduced or normal ejection fraction.

Unfortunately, because these drugs are new — the first SGLT2 inhibitor was approved by the Food and Drug Administration in 2020 to treat heart failure — many patients likely to benefit from them are not on them, in some cases because many physicians, including cardiologists, have yet to update their practice but also because of high co-pays and administrative burdens placed on clinicians by insurance companies.

Many people get their initial cardiomyopathy diagnosis after they’ve had difficulty breathing or experienced swelling in their extremities because of excess fluid in the body. Once diagnosed, though, many patients enter a stable phase — but staying in that stable phase requires work. Lifestyle changes, such as losing weight, restricting salt intake and exercising, are key for living a long and healthy life with cardiomyopathy, as is taking…



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