When Bill Clinton was released from a New York hospital on Friday, the world was reminded again about the importance of heart health.

The 63-year-old former president had two stents inserted into a clogged coronary artery after he had complained of chest pains last week.

Clinton's prognosis is favorable and he's expected to be back at work this week, which is, as it happens, Heart Failure Awareness Week.

Although February has been proclaimed American Heart Month since 1963, it had included no special recognition of heart failure until some 10 years ago when the Heart Failure Society of America (HFSA) claimed its own week.

Dr. Frank McGrew III, a cardiologist at the Stern Cardiovascular Center, said heart failure "is the only heart diagnosis that's increasing in incidence." Diseases such as heart attacks, he said, are decreasing in death rate and as a percentage of the population.

"That's because we have a pretty effective therapy for keeping people alive, but not making them well," McGrew said.

Heart failure usually develops slowly as the heart muscle weakens and needs to work harder to keep blood flowing. The HFSA says it happens after an injury to the heart, such as heart attack, long-term high blood pressure or a heart valve abnormality. It may not be recognized until it reaches the advanced state of congestive heart failure.

The HFSA says heart failure affects nearly 5 million Americans of all ages and is responsible for more hospitalizations than all forms of cancer combined. More than 400,000 new cases of heart failure will be diagnosed in the next year.

"The most common causes of heart failure in this country are high blood pressure and blockage of coronary arteries, the same thing that Bill Clinton had," said Dr. Guy Reed, chairman of the department of medicine in the College of Medicine at the University of Tennessee Health Science Center.

Reed said typical indicators people experience include "getting short of breath climbing stairs or going up a hill, or being short of breath lying in bed at night. Or their ankles swell or they're gaining weight not related to their diet because they're retaining fluid."

The ways to determine the presence of heart

failure, Reed said, include an ultrasound to check heart contraction and valves, a BNP (brain natriuretic peptide) hormone test, a chest X-ray to see if there are fluids in the lungs and a blood test to check kidney function.

McGrew said a cardiologist might order a series of tests starting with an echocardiogram and possibly a nuclear stress test or catheterization to make sure the arteries are OK. "Even in the absence of chest pain, you can still have a lot of artery blockage, particularly in people with diabetes."

McGrew added: "People must remember that a third of the time, the first manifestation of artery blockage is a sudden heart attack or sudden death. So the absence of symptoms is not reassurance that you're OK."

For Deon Hill, finding out about his heart condition was shattering.

Six years ago, when he was 25, he got the bad news that his heart function was dangerously low. "The surgeon came in and told me I had two years to live. He said I needed a heart transplant," Hill said.

"I was depressed, being very young finding out that I was dying. I had a wife and kids and you know, as a man you hold that all in."

Hill was diagnosed with cardiomyopathy and was referred to McGrew.

"He was the only one who really was like, 'OK, we can beat this,' " Hill said. "Everybody else expected it to get worse and he was the only one who told me we can reverse this and you can get better."

Hill said his weak heart had worked so hard it got huge. "I'd been in so many emergency rooms and they had done X-rays and they didn't know why. One time I got rushed and the guy came in and said 'I don't know if this means anything but you've got the biggest heart I've ever seen' and I was like, 'OK.' "

Hill was 330 pounds at the time and has since had lap band surgery.

And he takes care to stick with diet and exercise.

"I eat a lot of vegetables," he said. "I still do eat meat but mostly in salads. As far as exercise, now that my heart's almost back to normal, I try to exercise at least 30 minutes every day."

He said he's now down to 275 pounds and is aiming for his old high school weight of 230 when he played football.

McGrew said battling heart failure includes controlling high blood pressure, high cholesterol and diabetes. Frequent visits to the doctor will help and some adults would benefit from annual stress tests.

"If there's any concern about heart muscle function, promptly get an echocardiogram," he said. "We have a new test called calcium scoring where we do a CAT scan that can pick up very early hardening of the arteries to the heart years before a stress test becomes abnormal."

(And seeing the calcium in the hardened arteries is a great stimulus, he said, to get people to quit smoking).

Reed said, "In Memphis there's a high risk in African-Americans of high blood pressure causing heart failure, so control of blood pressure is a key thing, control of diet is a key thing."

He said most heart failure could be prevented if we did a better job with diet and exercise.

McGrew said regular exercise is important -- preferably daily but at least three or four days a week. "Less than that you don't get much benefit," he said. "And you need to do aerobic exercises: running, walking, cycling, rowing. Weightlifting doesn't count -- in fact weightlifting can be harmful in some people. It raises the blood pressure and makes the heart muscle thicker."As for diet, McGrew said, "Avoid fats, dairy products, red meat.The closer you get to a vegetarian diet the better you're going to be."

The Future of Heart Failure Treatment

Treatment for heart failure has markedly improved. In the past, there was an almost 80 percent death rate within five years, said Dr. Guy Reed, chairman of the department of medicine in the college of Medicine at The University of Tennessee Health Science Center.

Reed cites ACE-inhibitors and beta blockers as the cornerstone for treatment. He says pacemakers can make the heart more efficient by changing the timing of contraction of the heart, and in cases where heart function is significantly reduced, a defibrillator implant will shock the heart if it detects an abnormal rhythm.

Dr. Frank McGrew III, a cardiologist at the Stern Cardiovascular Center, said Stern typically has from 20 to 25 trials going on at any given time.

The more common systolic heart failure, McGrew says is usually treated with six medicines, and Stern has been involved in the studies on all of them, going back to digitalis, which was studied by the center's founder in 1920.

The less-common diastolic heart failure is when the heart muscle is not weak, but too stiff, and that causes the blood to back up in the lungs. The Stern Center is participating in the TOPCAT study testing a medicine that may reduce scar tissue formation in the heart. Another trial involves Sildenafil, better known as Viagra, which may lower pressure going into the lungs.

Stern's studies of hardware include research indicating benefits of pacemakers in more elderly patients, and testing of a small monitor under the skin to detect EKG changes that precede a heart attack and send a warning to the patient.

Trials involving stem cells are underway or being prepared. It is thought that they may be able to reduce scar tissue formation in the heart or grow new heart tissue. "We don't thoroughly understand how it works," McGrew said. "It may work as much by reducing inflammation as it does causing new cells to grow."

Reed says stem cell research, "Is an interesting area and it has promise, but the trials so far have been pretty disappointing.

Maybe we don't know how to use it yet."