Heart and circulatory disease is the UK’s biggest killer. It kills just under 240,000 people every year (four in 10 deaths) and can affect anyone at any time.
The good news is that over the last 40 years, excellent progress has been made in developing techniques that have revolutionised heart treatments, allowing many people to lead long and fulfilling lives despite having coronary heart disease.

One of the most dramatic areas of progress has been in heart transplantation. It has been more than 35 years since the first successful heart transplant was performed in South Africa in 1967, and due to research carried out by organisations such as the British Heart Foundation, the success of these techniques has dramatically improved since then. In the early 80s, about 75 per cent of patients survived the first year after transplantation; today, this figures is approximately 85 per cent. About 150 to 200 heart transplants are carried out in the UK each year, with 158 heart transplants being carried out between April 2002 and March 2003. The success of heart transplantation has been extended to heart-lung transplantation, which has enabled approximately 50 heart-lung transplants to be carried out in the UK each year.

This lifesaving work is restricted only by the number of donor organs available, and it is this shortage rather than the efficacy of the techniques that creates problems. Transplants are complicated by the fact that the organ donor’s blood type must be compatible with that of the patient, and the size and weight of the heart and lungs should be as similar as possible to that of the recipient. 
Even where a suitable donor is found, rejection is always a risk. This may occur at any point from the time of transplantation, up to six months after surgery. The problems of rejection have led to further research in order to increase successful transplantation rates.  It is now common practice to collect cell and tissue samples through a biopsy, in order to analyse them for signs of rejection. To help combat the body’s rejection of the new organs, a careful balance of immuno-suppressive drugs is needed before and after surgery.

Another crucial advance has been the introduction of left ventricular assist devices (LVADs), which can support the main pumping chamber of the heart when it becomes weakened. This weakening can lead to the heart and all other vital organs having a reduced supply of blood. The device is connected to the heart’s left ventricle, from where it transports oxygen-rich blood to a mechanical pump which then in turn transports the blood to the rest of the body.

Left ventricular assist devices are most commonly used to support a failing heart until a donor organ becomes available for transplantation. This means the device is only used in the short term and removed when a donor heart is transplanted. More recently, however, these devices have been used for people with severe heart failure who have been refused a heart transplant due to medical reasons. As the device is going to be used for the rest of their lives, this is known as “destination treatment”. The insertion of a left ventricular assist device in patients with end-stage heart failure is a high risk operation and is certainly not suitable for everyone. However, progress made with these techniques has been quick and promises further advances, suggesting exciting future prospects for the management of patients with severe heart failure.

The flip side of the excellent advances being made in treating people with heart failure, is that we expect more people to be living with the symptoms of this condition than ever before. Heart failure affects around 650,000 people in the UK and is estimated to cost the NHS around £625 million a year.
In order to help a situation where the number of patients living with heart failure is growing, the British Heart Foundation (BHF) has launched an integrated support system for heart failure using a lottery-funded £9 million specialist nurse network and a dedicated web-based service for heart failure patients, their families and carers.

Specialist care from a heart failure nurse has been shown to reduce hospital admissions, increase quality of life and encourage patients to manage their own medication, but few heart patients currently have access to the service. It is essential to note that while new techniques have revolutionised surgical procedures, money spent on rehabilitation and care services can be as important to a person’s long term quality of life.

Since the BHF was formed in 1961, tremendous progress has been made in the fight against heart disease. Thousands of lives have been saved, new drugs and surgical techniques have been developed and the quality of life for heart patients has been greatly improved. But heart and circulatory disease is still the UK’s biggest killer. We need to find out much more about the causes, diagnosis, treatment and prevention of heart disease, and support those who are living with heart disease. Our vision is for more patients to have access to a specialist nurse as a part of their rehabilitation services.