When the heart fails

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Heart failure occurs when the heart is unable to pump blood sufficiently to meet the needs of the body. Determining heart stress earlier in a patient can help doctors provide the correct treatment to avoid this.

Heart failure occurs when the heart is unable to pump blood sufficiently to meet the needs of the body. Determining heart stress earlier in a patient can help doctors provide the correct treatment to avoid this.

American doctor introduces new heart biomarker in PH  
According to the World Health Organization (WHO), out of 38 million people who died from non-communicable diseases in 2012, 17.5 million perished due to cardiovascular diseases (CVDs). With numbers this high, WHO officially declared CVDs as the No. 1 cause of death      globally, noting that the range of heart conditions are most prevalent in low- to middle-income countries.

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Alarmingly, such is also the case in the Philippines. Although no recent study has been conducted on CVD deaths in the country, an estimated 1.8 million Filipinos are suffering from heart failure (HF), which is classified as one of the most common types of CVDs.

To show just how dangerous a failing heart is, the Philippine Heart Association is now in the middle of a study that will form part of the National Nutrition and Health Survey.

Moreover, private institutions and individuals have also begun efforts to address the urgent health battle including American doctor Alan Maisel, who partnered with United Laboratories (Unilab) Inc. to introduce to the Philippines a new heart biomarker that has been saving lives in the United States.

In March, Dr. Maisel, who is a professor of medicine at the University of California and director of the Coronary Care Unit and Heart Failure Program of San Diego Veterans Hospital also in California, personally flew to Manila to attend a press briefing hosted by Unilab to talk more about this breakthrough called the ST2 cardiac biomarker.

“Heart failure sounds like such a terrible name because the ‘heart fails.’ It fails because it is unable to supply the amount of blood you need to carry out your daily activities,” Dr. Maisel began. “And guess what. We are in an epidemic especially with all the obesity and diabetes that lead to heart failure . . . [There is] more mortality than just about all the cancers combined.”

Dr. Alan Maisel, a professor of medicine at the University of California and the director of the Coronary Care Unit and Heart Failure Program of the San Diego Veterans Hospital, talks about the new ST2 cardiac biomarker method.

Dr. Alan Maisel, a professor of medicine at the University of California and the director of the Coronary Care Unit and Heart Failure Program of the San Diego Veterans Hospital, talks about the new ST2 cardiac biomarker method.

Unfortunately, he also observed that in the US, hospitalization often results in poor outcomes: there is a 90-day risk of death at 15 percent, and readmission is approximated at 30 percent, according to studies he considered.

“Some doctors may be sending home patients not knowing they could be sicker,” Dr. Maisel noted. This is where the ST2 cardiac biomarker comes in.

A novel indicator of heart stress due to worsening heart failure, it is a form of body protein, which is a member of the interleukin family. And for the American heart expert, ST2 sets a robust biomarker for two reasons.

First, it gives the same value whether blood is taken from different body parts unlike other biomarkers, which has a “coefficient of variation.” In other words, whether ST2 is measured from blood extracted from the arms or from the foot, or whether it is taken today or the next day, the ST2 level will pretty much stay the same.

He continued, “The second reason why I really like the ST2 is that it has a number that we can remember: 35 nanogram per milligram”

According to Maisel, this means that any patient with ST2 measurement above 35 has a much higher risk of death, compared to those below 35 with practically lesser risks.

The American doctor joined by Filipino physicians Dr. Dante Morales and Dr. Maria Rosario Sevilla hope to spread awareness about the availability of a new indicator of heart stress due to worsening heart failure in the Philippines.

The American doctor joined by Filipino physicians Dr. Dante Morales and Dr. Maria Rosario Sevilla hope to spread awareness about the availability of a new indicator of heart stress due to worsening heart failure in the Philippines.

Lastly, using this system further has the following advantages: It is not influenced by kidney and other body functions, age, and body mass index unlike other biomarkers.

To give a clearer picture of the process and results, Dr. Maisel recalled a personal story of a patient from his hospital in the US. “We just started using ST2 around three months ago. I checked on everyone who has been measured his ST2 at the Coronary Care Unit. One was a man came in, about 65 years old, with clear heart failure.”

This man’s ST2 was measured at 80 but when his signs improved, he was sent home even without his ST2 dropping to the safe levels. And fellow doctors ignored Dr. Maisel’s suggestion for an angiogram.

“He died over the weekend looking good and feeling good but with high ST2 level,” Dr, Maisel revealed. “Could I have saved his life if he wasn’t sent home just basing from his ST2 levels? I don’t know but I could’ve made a difference.”

With the help of ST2, doctors should be able to give better and more personalized medications to improve heart functions and prevent other complications.

Filipino doctors, Dr. Dante Morales and Dr. Maria Rosario Sevilla, joined Dr. Maisel at the presentation of the ST2 cardiac biomarker, which was held at The Peninsula Manila in Makati City. Together, they declared that their goal is to make physicians and nurses in the Philippines aware about the availability of the ST2 method in the country today, and ultimately save more lives from heart failure.

The ST2 method is now available as Pressage ST2 Assay, and exclusively distributed and marketed by Unilab. It is approved by the Food and Drug Administration and carries a Conformite Europeenne Mark.

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