Expert management of advanced heart failure

When you have heart failure, the heart is not able to pump as well as it should. Blood and fluid may back up into the lungs, and some parts of the body don’t get enough oxygen-rich blood to work normally. These problems caused by advanced heart failure lead to the symptoms you feel.

The cause of the heart failure will guide the treatment plan. If your heart failure is caused by a valve disorder, then surgery may be done to fix the valve. If your heart failure is caused by a disease, such as anemia, then the underlying disease will be treated. Although there is no cure for heart failure due to damaged heart muscle, the heart doctors here use many forms of treatment to manage the symptoms very effectively.

Heart conditions treated

  • Complex congenital heart disease
  • Coronary artery disease: inoperable
  • Cardiomyopathy: dilated
  • Cardiomyopathy: hypertrophic or restrictive (including sarcoidosis, LV non-compaction)
  • Cardiomyopathy: infiltrative (including amyloidosis and hemochromatosis)
  • Cardiomyopathy: ischemic
  • Hypoplastic left-heart syndrome
  • Interstitial lung disease
  • Inoperable valvular heart disease
  • Pulmonary artery hypertension
  • Refractory life-threatening arrhythmias

Advanced heart failure treatment options

Treatment plans for patients with advanced heart failure will be determined by the care team based on age, medical history, type and stage of heart failure, and personal preferences.

Advanced heart failure treatment options may include:

  • Controlling risk factors
  • Medications
  • Cardiac resynchronization therapy
  • Biventricular pacing
  • Heart transplant
  • Implantable cardioverter defibrillator
  • Ventricular assist devices (VADs)
  • CardioMEMS™ HF System—For individuals experiencing heart failure, blood pressure through the pulmonary artery (PA) can indicate worsening heart failure, even before symptoms—such as shortness of breath or weight gain—are evident. The CardioMEMS™ System features a small pressure-sensing device implanted directly into the pulmonary artery. Information is regularly transmitted to the patient’s care team, enabling doctors to use the information to adjust medications and treatment plans without the need to visit the clinic or hospital.

Advanced heart failure frequently asked questions

  • What happens during a heart failure evaluation at the Center for Advanced Heart and Lung Disease?

    The heart failure evaluation is used to determine two primary areas:

    • Evaluation for cause—This includes assessment for the presence of coronary artery disease, usually via cardiac catheterization, stress testing, echocardiogram, basic laboratory tests and/or ECG. Further testing could be needed based on what is found on these screening exams.
    • Evaluation for factors that affect heart failure—This includes smoking, drug/alcohol use, high blood pressure, high cholesterol, abnormal heart rhythms, diabetes control, weight management, exercise, thyroid disease, anemia and sleep apnea.
  • What kind of heart failure treatment is available?
    • ACE inhibitors and ARBs—These medications are the cornerstone of heart failure treatments. While ACE inhibitors are the mainstay, ARBs may be used if you cannot tolerate ACE inhibitors. Both of these classes of drugs are used in heart failure treatment to reduce dilation and restore the heart to its normal shape.
    • Beta blockers—Beta blockers provide the greatest potential benefit of all possible medications. Some beta blockers have been proven to help the heart return to its normal shape/function. These are started at low dose and are gradually adjusted, as tolerated.
    • Aldosterone antagonists—The third line of medical therapy for treating patients with advanced heart failure is used in low doses in combination with the above. This medication is used to prevent your body from losing potassium, and it is a mild diuretic.
    • Digoxin—This last line of medical therapy, in addition to the three above, has been shown to decrease the risk of hospitalizations for patients diagnosed with advanced heart failure.
    • Diuretics—These are used to manage swelling and fluid retention for advanced heart failure.
    • ICD (implantable cardioverter defibrillator)—This small device is placed under the skin of the chest. An ICD is designed to prevent a person from dying suddenly from a dangerous heart rhythm.
    • Low-sodium diet—Patients with advanced heart failure should restrict sodium (salt) to 2,000 mg per day. Dietitians are available to assist you with your dietary plan.
    • Exercise is very important. Please discuss this with your provider.
  • What kind of treatment might be used for stiff heart or diastolic heart failure?
    • No medication has been shown to help a stiff heart relax; therefore, most therapies are aimed at controlling factors that worsen the condition, such as hypertension, diabetes and sleep apnea.
    • Diuretics can be used to help manage swelling and fluid retention.
  • How can I avoid getting a heart transplant?

    The better you can control your heart failure and the aggravating factors, the greater the possibility that you could postpone or prevent the need for a heart transplant or left ventricular assist device (LVAD).

  • What conditions are treated at the Center for Advanced Heart and Lung Disease?
    • Dilated cardiomyopathy
    • Ischemic cardiomyopathy
    • Restrictive cardiomyopathy (including amyloidosis, sarcoidosis, hypertrophic cardiomyopathy, LV non-compaction)
    • Pulmonary artery hypertension