Taken to Heart

Some five million Americans have heart failure, making it one of the nation's highest-morbidity, highest-mortality diseases. And although modern medicine continues advancing the prevention and treatment of heart failure, there is much to be learned about how to best treat the person behind the disease.

"Because heart failure is chronic, there's a deep and prolonged impact on people's lives in all aspects," says Laura Wood '85, a clinical research coordinator at the Duke Center for Integrative Medicine. "Heart-failure patients often experience depression, anxiety, unresolved issues, and reduced quality of life, which is why we're looking at a mind-body-spirit [MBS] treatment approach."

Wood oversees a Medtronic Foundation grant being used in part to fund the SEARCH study (Support, Education and Research in Chronic Heart Failure). SEARCH, now halfway through its three-year duration, delivers an eight-week, patient-centered MBS intervention to chronic heart-failure outpatients.

"SEARCH is about evaluating an education program that addresses the coping needs of heart-failure patients--with the ultimate goal of improving patient care by developing a better understanding of the relationship between stress, emotions, spirituality, and heart failure," says Wood. "We're studying the suggestion that MBS therapies can improve the quality of life for these patients."

SEARCH participants meet weekly for several hours and, after a period of mindfulness meditation practice, a topic is presented by the session leader and discussed among participants, within an expressive support-group model. "The goal is to learn about, discuss, and practice mindful-awareness skills for stress reduction, as well as issues like spirituality and health, assertive communication, learned optimism, grief, and death," says Wood. "The work people do is highly individual, and they learn to change their focus from 'I can't' to 'I can.' "

Most of the study's current eighty or so participants come from Duke's Heart Failure Clinic, although some are area referrals. Roger Gutierrez is one of those participants. After suffering a heart attack at age forty-one, the school counselor and father of two learned that he suffers from heart failure. Besides performing a successful angioplasty and making recommendations about diet and activity modification, Gutierrez's Duke cardiologist and principal SEARCH investigator Marty Sullivan referred him to the study.

"Although mine was a diverse group, we shared many of the same thoughts and experiences," Gutierrez says. "The last several weeks included discussions about death and what it meant to us--pre-diagnosis and now--and that was very powerful. When you have a near-death experience or serious illness, you really tend to look inward."

"Participating in the SEARCH study was a gateway to my putting things in perspective and being mindful of my life on many different levels," he says. "Although the program has spiritual components, it's not religious in the way people might think; it's very focused on the individual, so people can apply their own backgrounds and beliefs."

Gutierrez says he believes "there's a huge missing component, especially within cardiology; often it's an evaluation, a medication adjustment, and you're gone. That Duke is taking time to educate people is a big step toward prevention and teaching people to manage their symptoms by making better choices. The greatest benefit to learning MBS techniques is that it's empowering and encourages self-responsibility."

The fact that spouses and partners are also welcome "has been key to helping me keep with the program," he says. "My wife benefited not only from the MBS techniques, but she also learned about cardiac terminology, medications, nutrition, symptoms, and what to expect. And she received lots of support and encouragement."

The second cohort of SEARCH participants recently completed the twelve-month follow-up and, although data are not yet available, "the observation of our research team is that a number of patients have had a noticeable improvement in quality of life after participating," Wood says. "If we're able to capture what we see happening in hard data, we can then take steps to integrate a MBS approach into standard heart-failure therapy."

SEARCH data will be specific to heart failure, but, Wood says, other studies indicate that similar programs can help people with other illnesses. "The theory and intervention techniques could be transferred to asthma, diabetes, and cancer," she says. "It's important to raise awareness that this type of program can be beneficial to the general population."