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Heart Failure Treatment

Treatment of heart failure includes medication, heart transplant, ventricular assist devices (VADs) and total artificial hearts.

There are also other options available for these patients, including:

• Cardiac resynchronization therapy
• Advanced medicines
• Clinical trials relating to heart failure medications
• New pressure sensors that patients can use at home. Medical therapy can be adjusted on a daily basis, guided by changes in these pressure sensors

There are many treatment tools available that can change outcomes if we get them at an appropriate time.

Medications

The treatment for heart failure starts with oral medications. Aurora has dedicated cardiologists who specialize in heart failure. They maximize medical therapy—dose, frequency and types of medications—provided to patients in order to keep heart failure under control.

Heart failure is a roller coaster ride. Sometimes patients will go long periods without an acute decompensation episode, which is a period of sudden shortness of breath, lack of oxygen and drop in blood pressure. This may result in the need for a hospital visit for a “tune-up,” an increase in medication. Sometimes it means the patient needs intravenous (IV) medication to help the heart to pump and to get extra fluid out of the body.

Patients with compensated (stable) heart failure can go a long time without any issues.

Patients who come to Aurora for our Transplant and Mechanical Circulatory Support Program are those who have failed medical therapy, meaning that medicines have been optimized and it isn’t enough. They are still symptomatic, they are still fatigued, they are still short of breath, they can’t do what they want to do and they are looking for something further.

IV medications, which can help a heart failure patient temporarily, over time, may lead to a higher death rate because of the risk of ventricular arrhythmias, ventricular fibrillations and sudden cardiac death.

Heart Transplant

If a patient has failed medical therapy, the Aurora Heart Failure Clinic may further optimize the treatment and evaluate whether that person is a candidate for heart transplantation. This means he/she is in end-stage heart failure.

A patient eligible for heart transplant is further evaluated to ensure success. Aurora’s transplant team will look at the following:

• Are the lungs in good enough shape?
• Is the patient’s psycho-social situation good enough?
• Does the patient have enough support from family members?
• Are the patient’s kidneys good enough to go through an operation?
• Does the patient have peripheral vascular disease or problems with complications of diabetes that would limit his/her ability to survive a transplant and limit survival after heart transplantation?

Ventricular Assist Device

A ventricular assist device (VAD) is an artificial pump that is surgically implanted and basically drains blood from the heart and pumps it out to the aorta, which is the main blood vessel that distributes blood to the body. It has the advantage over donor hearts, which are in short supply…

Ventricular assist devices often are used for a patient we are trying to keep alive or improve circulation to major organs during the wait for a heart transplant or sometimes called “bridge to transplant,”

Sometimes VADs are used in patients who are not candidates for transplant, the main reason being age. In the Aurora Heart Failure program, patients age 72 to 79 are potential candidates for destination therapy, which means the goal is not to get to a new heart, but rather to improve quality of life and to improve survival with a VAD. These patients are not candidates for heart transplant, and the pump is never going to be removed. The pump can be changed if there is a mechanical failure with surgery.

The average hospital stay after we implant a VAD is two weeks—a week to take care of your medical problems and a week of education so that both you and your family are comfortable with the alarms, the dressing changes and all the other care that is required for taking care of a patient who has a mechanical circulatory support device.

Total Artificial Heart

A total artificial heart is a surgically placed mechanical pump that supports both sides of the heart. These are used in a very limited number of patients due to the fact that the portable driver (power supply) has strict requirements related to discharge to home. We have used it at St. Luke’s with success as a “bridge to transplant.”