New Approach For Patients With Advanced Heart Failure

Many Americans are living with congestive heart failure (CHF), which produces a number of symptoms due to progressive deterioration of heart function. These symptoms include shortness of breath, fatigue, fluid retention and leg swelling. In severe cases, CHF can require hospitalization and aggressive medical therapy to relieve these symptoms. Fortunately for most patients, medicines and lifestyle alterations, as prescribed by their physicians, can prevent worsening of CHF symptoms. However, for some patients, CHF can lead to a progressive decline in overall health and level of function. Some patients may not be able to leave the house, or may require frequent hospitalizations. For these patients, medical therapy may not be enough – they may need more aggressive forms of therapy, including heart transplant or left ventricular assist device therapy.

Heart transplant is the gold standard treatment for severe, end-stage heart failure. It has outstanding long-term success rates and is well tolerated by most patients. However, due to persistent shortages in organ donation, heart transplants are not available for all people who may benefit from them.

For patients who are not candidates for a heart transplant, or for those patients who are so sick that they cannot survive until a heart is available, left vetricular assist device (LVAD) therapy is available as a treatment for end-stage CHF. Since 2004, LVADs have been approved for use as a so-called “bridge-to-transplant.” For these patients, an LVAD will keep them healthy until a heart becomes available, at which point the LVAD is removed. In 2010, the FDA approved the use of LVADs for “destination therapy” for patients who could not receive a heart transplant. For these patients, an LVAD serves as a permanent treatment for heart failure, and they will live with their LVAD for the rest of their lives.

To be a candidate for “destination LVAD therapy,” patients must have severe, non-reversible CHF and have already been treated with optimal medical management for some time. They must be ineligible for a heart transplant, often due to advanced age (over 70). “Bridge-to-transplant” patients must have been accepted by a transplant center and have an imminent risk of death without further treatment.

These are some of the other signs and symptoms which may indicate that a patient has CHF severe enough to consider LVAD therapy:

  • Repeated hospitalizations
  • Inability to walk one block without shortness of breath
  • Need to cut back on heart failure medications due to low blood pressure, such as:
    • ACE inhibitors
    • Beta blockers
  • Increasing diuretic dose, such as:
    • Lasix
    • Recurrent pulmonary edema (fluid in lungs)
    • Weight loss due to CHF
  • Recurrent ventricular arrhythmias (irregular heart rhythms)
  • Progressive kidney dysfunction due to CHF
  • Lack of response to bi-ventricular pacemaker therapy