Heart Failure

What is Congestive Heart Failure? Can I Prevent It?

Heart Disease Risk QuizMore than 5 million Americans live with Congestive Heart Failure, and heart failure costs the United States more than $32 billion dollars each year, according to the Centers for Disease Control and Prevention (CDC). Congestive heart failure affects all ages including children, adolescents, adults and the elderly, and is equally prevalent among women and men. There are two conditions that cause congestive heart failure; systolic dysfunction and diastolic dysfunction. Systolic dysfunction is when the heart muscle becomes weak and cannot pump blood adequately. Diastolic dysfunction is when the heart muscle becomes very thick and stiff making it difficult for the heart to fill with blood (often a result of poorly controlled high blood pressure and a frequent causes of heart failure hospital admissions in women).

Congestive heart failure occurs when the heart is not able to pump blood to all the organs and tissues of the body (either because it is too weak or because it is not filling well enough). Instead of going where it needs to go, fluid can back up into different organs in the body. This fluid “congestion” is what gives this condition its name. Initial symptoms of congestive heart failure are swelling, heavy breathing and fatigue.

Symptoms of Congestive Heart Failure

Some examples of the effect congestive heart failure can have on different organs of the body are:

  • The lungs can become congested – called a pulmonary edema – which can lead to breathing problems, a decreased ability to exercise, and fatigue.
  • Fluid can build up in the liver, which decreases its ability to get rid of the body’s toxins and create important proteins needed to function.
  • The Gastro-intestinal tract can be affected and may become less likely to absorb much-needed nutrients and medicines.
  • Fluid also commonly swells up in the ankles, feet, legs and arms – called edema.
  • Eventually, if untreated, all parts of the body can be negatively affected.

The good news is that congestive heart failure can be prevented!

Preventing Congestive Heart Failure

  • Regularly monitor your blood pressure and if you are diagnosed with hypertension work with your physician to develop the best approach to lower it. Blood pressure control is the best way to stop congestive heart failure from occurring
  • Quit smoking
  • Lose weight (if you are overweight)
  • Exercise more often – it is recommended to exercise 30 minutes a day, 5 days a week in order to keep your heart healthy and reduce risk of developing coronary artery disease
  • Surgery, when appropriate, for those patients with congestive heart failure due to valvular disease.
  • Medication – work with your Emory Women’s Heart Center specialist to develop the best treatment plan for you if you have had a heart attack or have high blood pressure. This will ensure your heart maintains the best condition possible as you move forward.

 

Heart Disease Screening

Heart disease may be prevented if you are motivated to take the necessary steps to protect your heart! Schedule your comprehensive cardiovascular screening today to assess your risk for heart disease and to develop your personalized prevention plan.

Take action today to potentially save a life!

Related Resources:

 

About the Emory Women’s Heart Center

Emory Women’s Heart Center is a unique program dedicated to screening, preventing and treating heart disease in women. The Center, led by nationally renowned cardiologist Gina Lundberg, MD provides comprehensive cardiac risk assessment and screenings for patients at risk for heart disease as well as full range of treatment options for women already diagnosed with heart disease care. Find out if you are at risk for heart disease by scheduling your comprehensive cardiac screening. Call 404-778-7777.

Alexis Cutchins, MD is Assistant Professor of Medicine at Emory University School of Medicine. Dr. Cutchins completed medical school at Emory University School of Medicine before going to New York Presbyterian Hospital for her Internship and Residency in Internal Medicine. She completed an NIH-supported research fellowship in Vascular Biology and a clinical fellowship in Cardiovascular Diseases at the University of Virginia in 2012. She has a special interest in heart disease in women in addition to heart disease prevention and risk reduction in cardiology patients.

 

About Dr. Cutchins

Dr. Alexis CutchinsDr. Cutchins has published several different articles on adipose tissue distribution and obesity in journals such as Circulation Research, Arteriosclerosis Thrombosis and Vascular Biology and Stroke and has a special interest in the effects of adipose tissue distribution on the heart.

Dr. Cutchins is board certified in Internal Medicine (2007) and Cardiovascular Diseases (2012). She is a member of several professional organizations including the American Heart Association and the American College of Cardiology.

Dr. Cutchins sees patients at Emory Heart & Vascular Center at Emory University Hospital Midtown and Emory Heart & Vascular Center at Emory Saint Joseph’s.
She enjoys spending time outdoors with her husband, their three daughters and their dog. She loves to cook and ride horses.

Welcoming New Medical Director of the Saint Joseph’s Hospital Heart Failure Clinic

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Dr. David Markham, MD, MSc

Emory Center for Heart Failure and Transplantation and Saint Joseph’s Hospital are pleased to welcome David Markham, MD, MSc, to the team as the medical director of the Heart Failure Clinic at Saint Joseph’s Hospital.

Markham is an experienced heart failure and transplant cardiologist and has performed groundbreaking work in the area of assist device physiology.

“I’m excited that Dr. Markham will be leading heart failure services and our partnership with Saint Joseph’s,” says Andrew Smith, MD, director of the Center for Heart Failure and Transplantation and chief of cardiology at Emory University Hospital. “He will continue the progress we’ve already made over the past few months with the Advanced Heart Failure Network and the consolidation of services for network patients at Emory University Hospital, Emory University Hospital Midtown and Saint Joseph’s Hospital. These steps benefit our patients and enhance the services we offer.”

Markham received his undergraduate and medical degrees from Emory in 1991 and 1995, respectively and is a native of Marietta, GA. He completed an internship and residency at the University of Virginia, a post-doctoral fellowship in clinical and molecular cardiology at the University of Texas (UT) Southwestern Medical Center at Dallas, and a fellowship in cardiology with advanced training in heart failure and cardiac transplantation at Duke University Medical Center.

Before his return to Emory, Markham was medical director of the Heart Failure Clinic at Parkland Memorial Hospital and associate director of heart failure, assist devices and cardiac transplantation at UT Southwestern Medical Center in Dallas.

About the Emory and Saint Joseph’s Center for Advanced Heart Failure

The Advanced Heart Failure Network is an enhanced cardiac collaboration that includes expert care from subspecialists at Emory University Hospital, Emory University Hospital Midtown and Saint Joseph’s Hospital of Atlanta. For over 20 years Emory Healthcare and Saint Joseph’s Hospital have had the largest advanced heart failure programs in Georgia. The new collaboration will focus on meeting the needs of patients and their families dealing with heart failure. Patients in need of advanced heart failure management, medical and surgical management of other heart conditions and related therapies, may now access treatment at any of the three facilities.

Related Resources

Emory Honored with International Heart Failure Research Grant!

Emory is one of 17 collaborating centers from 10 countries participating in a new international consortium project aimed at earlier detection and prevention of heart failure.

The European Commission has awarded a grant of almost $16 million (EUR 12 million) to the Heart Omics in Ageing (HOMAGE) project, with a goal of better identifying more specific biomarkers for heart failure and then developing methods for earlier detection of risk in the elderly population.

A biomarker, or biological marker, is a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. It serves as a guide for health and physiology related assessments.

The prevalence of heart failure is increasing worldwide because of the aging population and a rising trend of risk factors for heart disease — such as diabetes, obesity and hypertension. Heart failure is a major cause of death and disability in the world and remains the most frequent cause of hospitalization for patients over 65 years old. An essential step in preventing heart failure is to first accurately identify individuals at high-risk.

Traditional risk factors such as high blood pressure still remain important clinical guides but we are now seeing more cases of heart failure develop in individuals who do not have any specific high risk diseases. Therefore, this research will try to determine more accurate methods of detecting heart failure risk using biomarkers leveraging the latest technology.

This project will evaluate data from 30,000 patients from 10 countries. Emory investigators will work with the National Institutes of Aging-funded Health Aging and Body Composition Study, to assess the value of this approach among 3,000 elderly individuals in the U.S.

HOMAGE will also lead a clinical trial to look for novel treatments of heart failure that can be targeted specifically to those patients at risk.

This research has the potential to benefit thousands of individuals in the U.S. and researchers at Emory are very excited to work with colleagues across Europe in this trans-Atlantic collaboration.

About Dr. Javed Butler
Professor of Medicine, Emory University School of Medicine
Director of Heart Failure Research at Emory

After completing medical school from Aga Khan University in Karachi, Pakistan, Dr. Butler did his residency and chief residency at Yale University, Masters in Public Health from Harvard University, and cardiology fellowship including transplant training at Vanderbilt University. Before moving to Emory University, he was the director for the Heart and Heart-Lung Transplant programs at Vanderbilt University. He also has done special cardiac imaging training at the Massachusetts General Hospital. He is on the Editorial Board for the Journal of the American College of Cardiology, Journal of Cardiac Failure, American Heart Journal and Congestive Heart Failure. He served on the American College of Cardiology Committee on Heart Failure and Transplantation. He is board certified in Cardiology, Internal Medicine, and Nuclear Cardiology. Currently he serves as the Deputy Chief Science Advisor for the American Heart Association. While also heavily involved in research and clinical care at Emory. Dr. Butler’s research focuses primarily on the disease progression, outcomes, and prognosis determination in patients with heart failure, with special emphasis on patients undergoing cardiac transplantation and left ventricular assist device placement. He has published many original research articles in multiple peer reviewed journals. He serves on the national board, events committee, and steering committees of several multicenter clinical trials. Dr. Butler is involved in the evaluation and management of all aspects of patients with heart failure including cardiac transplantation and left ventricular assist devices. He is also involved in the cardiac CT program at Emory University.

Related Resources

Are You 1 of the 50 million People Caring for an Ill, Disabled or Aging Family Member?

Heart Failure CaregiversApproximately 50 million people in the United States provide care for a chronically ill, disabled or aged family member. Although most of a caregiver’s attention goes to caring for the family member, caregivers also need to pay careful attention to their own health to avoid health problems in themselves. Nurses at Emory’s Nell Hodgson School of Nursing are conducting research to determine how incorporating the promotion of educational programs and physical activity into the lives of caregivers providing support for heart failure patients can help improve caregiver health and reduce their own cardiovascular risk.

Caregivers can be more prone to suffer from chronic stress, which may lead to worsened health, earlier aging, increased risk for chronic illnesses, and higher mortality rates than adults of the same age who are not family caregivers. Chronic stress has its own risks, such as increased cardiovascular risk factors and risk of fatal and nonfatal cardiac events. Unfortunately, providing this essential type of support often leads to caregiver distress, depression, poor sleep, and reduced quality of life. Adult children caring from a chronically ill parent show rates for depression and/or anxiety that are twice as high as those of non-caregivers. Furthermore, caregivers providing support for a spouse experience rates of depression or anxiety six times higher than non-caregivers. A wife’s hospitalization for any reason increases her husband’s chances of dying within a month by 35%, whereas a husband’s hospitalization increased his wife’s mortality risk by 44%. Many caregivers of patients chronically ill with heart failure are also older adults themselves, making them more susceptible to illness.

Caregiver stress can be caused by the physical and mental demands of care-giving, as well as by the family relationship. In contrast, positive mental health effects can emerge when caregivers feel a greater level of help is provided, suggesting positive meaning may be derived from care giving experiences. Effective interventions to reduce stress and distress among caregivers of chronically ill populations include the incorporation of educational programs and cognitive behavioral therapy into the lives of caregivers and patients. Additionally, physical activity interventions have resulted in improved caregiver physical health, reduced depression, reduced blood pressure reactivity, and improved sleep quality.

Findings from interventional studies related to the caregivers of heart failure patients, specifically, have no yet been reported, but Emory nurses are hopeful that the interventions developed through this research will improve the overall emotional and physical health status of these family caregivers who are essential in the lives of patients chronically ill from heart failure.

Renowned Emory nurse, Dr. Sandra Dunbar from the School of Nursing is leading the Caregiver Stress study for Family Members of Heart Failure Patients. For more information contact: Mary Laszlo, CCRC, research project manager, at 404-712-8478.

Related Resources:

True Coordination of Care: Our New Advanced Heart Failure Program

Advanced Heart Failure ProgramWe’ve experienced quite a bit of growth and expansion over the last few years here at Emory Healthcare, and with that growth, our patients are continually afforded a more collaborative and integrated total care experience. When Saint Joseph’s Hospital became part of the Emory Healthcare family earlier this year, for example, two of the state’s leading heart and vascular care providers became one, making comprehensive cardiac care a seamless process for our patients.

Every day we take steps to make receiving care at any one of our Emory Healthcare facilities more convenient and our latest effort has resulted in one of the most comprehensive heart failure treatment programs in the country. The new Advanced Heart Failure Program, is a cardiac network that includes the expert care from subspecialists at Emory University Hospital (EUH), Emory University Hospital Midtown (EUHM) and Saint Joseph’s Hospital of Atlanta.

For over 20 years Emory Healthcare and Saint Joseph’s Hospital have had the largest advanced heart failure programs in Georgia and the new collaboration will focus on meeting the needs of patients and referring physicians across the Southeast. EUH, EUHM and Saint Joseph’s have established cultures of excellent multidisciplinary care with emphasis on the lives of patients and families dealing with heart failure. We are excited to expand the bond of physicians, nurses, dietitians, social workers, and others in improving outcomes for those we serve.

The surgical heart transplant services at Saint Joseph’s Hospital will be the only component of its current heart failure program to move to a new campus—transplants now will be performed by Emory Transplant Center surgeons only at Emory University Hospital. Heart failure patients will receive pre- and post-operative care from their physician of choice at Saint Joseph’s, EUH and EUHM. Patients in need of advanced heart failure management, medical and surgical management of all heart conditions and related therapies may access treatment at any of the three facilities. Saint Joseph’s patients on the heart transplant wait list are in the process of being transferred to transplant centers of their choice, including Emory. Their status and place on the wait list will not be impacted since it is regulated by UNOS.

The program’s services also will include the surgical implantation of ventricular assist devices (VADs) at Emory University Hospital and Saint Joseph’s—a growing enterprise because of improved technology—and the medical management of VADs at all three hospitals.

The goal of the program is for all of our heart failure and transplant patients to experience enhanced coordination of their overall care and increased communication between their medical and surgical specialists.

The program currently has five cardiologists who are certified in advanced heart failure and transplantation and a number of other cardiologists pursuing certification who will be available to see patients. The Emory School of Medicine has an accredited advanced heart failure and transplantation fellowship training program for cardiologists. In addition, Emory is one of only nine centers in the country that is a member of the Heart Failure Clinical Research Network (HFCRN), sponsored by the National Heart, Lung and Blood Institute. Earlier this year, Emory received a seven-year, $2.7 million grant to develop heart failure clinical trials, with additional funding down the road to carry them out. Dr. Javed Butler, professor of cardiology, is principal investigator. As part of our new merger, Saint Joseph’s will participate in upcoming HFCRN trials, too.

 

About Andy Smith, MD, Director of Heart Failure and Transplantation, Bahgat/Smith Endowed Chair in Heart Failure Therapy and chief of cardiology at EUH

Dr. Andrew Lee Smith, Emory HealthcareAndrew Lee Smith, MD joined Emory University’s faculty in 1992 and established the Center for Heart Failure Therapy and Transplantation, a specialty practice for treatment of patients with heart failure in all stages (early to end stage) of the disease. Under his leadership, heart failure outpatient visits have surpassed 5000 annually, over 500 heart transplant procedures have been performed since the program began, and the Ventricular Assist Device program is strong and growing. Dr. Smith is recognized as an innovative leader in the treatment of heart failure and most notably for his work in collaboration with electrophysiologists on cardiac resynchronization therapy which lead to FDA approval for these devices. To learn more about Andrew Lee Smith, MD, check out Dr. Smith’s physician profile.

Astounding Percentage of Heart Failure Patients Suffer Post-Traumatic Stress Disorder

Stress & Heart Attack RiskAn alarming percentage of people who suffer heart attacks or other acute coronary events, one in eight, experience clinically significant symptoms of post-traumatic stress disorder (PTSD).

PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical or personal harm occurred or was threatened to occur. Post-traumatic stress disorder, usually, associated with military personal after war or sexual assault victims, is now being referenced for heart failure patients.

Each year, about 1.4 million people in the United States experience an acute coronary syndrome (ACS), a condition brought about by sudden reduced blood flow to the heart. The most common symptom prompting diagnosis of ACS is chest pain, often radiating of the left arm or angle of the jaw, pressure-like in character, and associated with nausea and sweating. Numerous small studies have suggested that ACS-induced PTSD is common and can have serious health consequences, but its prevalence is not known.

To understand the severity of the problem, the first combined review, or meta-analysis, of clinical studies of ACS-induced PTSD was recently conducted. The 24 studies in the meta-analysis included a total of 2,383 ACS patients from around the globe.

The research conducted suggests that clinically significant PTSD symptoms induced by ACS are moderately prevalent and are associated with increased risk for recurrent cardiac events and mortality. Although, further tests of the association of ACS-induced PTSD and clinical outcomes are needed, the numbers are significant; overall 12 percent (one in eight) of the patients in the study developed clinically significant PTSD symptoms and four percent of study participants met full diagnostic criteria for the ACS-induced PTSD.

Dr. Donald Edmondson, leader of the study, stated, “Given that some 1.4 million ACS patients are discharged from the U.S. hospitals each year, our results suggest that 168,000 patients will develop clinically significant PTSD symptoms. That is quite substantial. However, there is abundant evidence that psychological disorders in heart patients are under recognized and undertreated. In fact, under diagnosis may be even more pronounced in cardiac practices than in other types of medical practices.”  Edmondson also states that “Fortunately, there are good treatments for people with PTSD, but first, physicians and patients have to be aware that this is a problem. Family members can also help. We know that social support is a good protective factor against PTSD due to any type of traumatic event.”

For more information on the ACS induced PTSD analysis, you can review the paper titled “Posttraumatic Stress Disorder Induced by Acute Coronary Syndrome: A meta analytic review of prevalence and associated clinical outcomes.” or check out the video below with Emory’s, Dr. Laurence Sperling, Director for the Center of Heart Disease prevention at the Emory Clinic.

Heart Transplant Patient Success Story

Dr. Vega, Emory Heart and VascularHerbert Grable was diagnosed in 2000 with congestive heart failure. When he was diagnosed, it came as a shock and he was scared. He didn’t know what caused his heart to fail and he didn’t know what heart failure treatments were available for him. He was very grateful to have the Emory Heart & Vascular Center near his home, as it offered a unique treatment for patients who are not candidates or can’t get a heart transplant right away – called Ventricular Assist Devices (VAD).

As we have discussed in previous blogs, a VAD is a mechanical device that is implanted in the heart. This pump takes over the function for the ventricle and circulates blood to the rest of the body. The goal of a VAD is to improve a patient’s survival and quality of life while they wait for a transplant (if they are a candidate for a transplant). The number of heart failure patients is tremendous, and with the number of transplants regulated per year at around 2,500 the VAD is another option for non-transplantable candidates as well.

After receiving the VAD, Herbert smiled and joked that he felt like himself again. His wife commented that the she got the “old Herbert back.” After eight months with the VAD, Herbert was again upgraded to the transplant list. One week later, he received the call  from Emory Transplant Center that a heart was available for him. Before transplant, Herbert was scared but he had faith in Emory and was determined that everything would work out. His wife was hopeful and optimistic that Herbert would be with her for many more years and would possibly see some grand kids one day.

Transplants are complex procedures. Emory transplant physicians are experts in their field and aware of all possible nuances that occur with each individual transplant patient. Should an unusual complication arise during a transplant experience, Emory has the skill to reach the most optimal outcome for a patient.

After Herbert received the heart transplant, he was able to live a normal lifestyle and do everything he always did before he was diagnosed with heart failure. He sums up his care “Emory is not just hospital, they care about the patient as well. I am so glad to have a place like Emory to treat me for this condition.”

For more information about heart transplant after the VAD procedure, watch this video:

About Dr. Vega

Dr. David Vega is a cardiothoracic surgeon at the Emory Heart & Vascular Center and the Director of Emory’s Heart Transplant program at Emory University Hospital. He implanted Georgia’s first dual pump ventricular assist device (VAD) in 1999 to serve as a bridge to heart transplantation, a procedure that initiated Emory’s ongoing national position at the forefront of the use of mechanical circulatory assist devices. In 2006, he implanted the state’s first VAD as a form of destination therapy for individuals who are ineligible for or are unwilling to undergo a heart transplant, and in 2007 he implanted an even smaller VAD for the same purpose that featured an automatic speed control mode designed to regulate pumping activity based on different levels of patient or cardiac activity.

Heart Failure – What Should I Know?

Sonjoy Laskar MD

A heart failure diagnosis may sound frightening, but with the right treatment, heart failure can be controlled. Once you are on a stable medical regimen, you can often return to a full and enjoyable life. With the recent passing of actress and icon, Elizabeth Taylor, we would like to take some time to provide some information about congestive heart failure.

Facts:

  • Congestive Heart Failure (CHF) affects nearly 5 million Americans
  • Approximately 550,000 new cases are diagnosed in the U.S. each year.
  • Congestive heart failure affects people of all ages, from children and young adults to the middle-aged and the elderly.
  • Almost 1.4 million persons with CHF are under 60 years of age.
  • CHF is present in 2 percent of persons age 40 to 59.
  • More than 5 percent of persons age 60 to 69 have CHF.
  • CHF annual incidence approaches 10 per 1,000 population after 65 years of age.
  • The incidence of CHF is equally frequent in men and women, and African-Americans are 1.5 times more likely to develop heart failure than Caucasians.
  • More than half of those who develop CHF die within 5 years of diagnosis.

Symptoms:

  • Shortness of breath with little exertion
  • Feeling weak or tired after little activity or exertion
  • Difficulty sleeping due to breathing problems
  • A new or different cough, especially while lying flat
  • A swollen and/or tender abdomen
  • Loss of appetite
  • Increased urination at night
  • Swelling of the feet and legs

Early diagnosis and treatment for heart failure is very important. Heart failure is a chronic condition that may follow a varied and unpredictable course. If you are experiencing heart failure symptoms, you should see your cardiologist. If you have been diagnosed with heart failure, adhering to the treatment plan designed by your doctors and nurses can help you navigate this challenge. Your symptoms can be controlled with proper medical care.

About Sonjoy Laskar, MD:
Dr. Laskar joined Emory Healthcare in 2005 and has devoted his career to providing direct care to patients with heart failure, heart transplantation and ventricular assist devices, as well as to teaching residents and fellows. He is an active researcher in the areas of echocardiography and ventricular assist devices as destination therapy, and is a member of the American College of Cardiology, Heart Failure Society of America and the International Society of Heart and Lung Transplantation

Understanding Heart Failure

Heart failure, put simply, is a condition in which the heart doesn’t pump as well as it should. Nearly 5 million Americans currently suffer from it, and approximately 550,000 new cases are diagnosed every year. So, why does it occur? Unfortunately there’s no straightforward answer to this question—heart failure can stem from a number of factors, including diabetes, obesity, lung disease, coronary artery disease, heart valve disease, congenital heart disease, irregular heartbeats, long standing high blood pressure and more.

A normal, healthy heart pumps plenty of oxygen-rich blood out of the heart and into the system, nourishing the entire body. Signs of heart failure enter the equation when the heart doesn’t eject blood efficiently enough to meet these oxygen demands. The condition can occur suddenly, or it may advance slowly over time.

In order to understand heart failure, we must first examine the two main types: systolic and diastolic. With every heartbeat, the heart contracts and relaxes. Systolic heart failure (the most common type) occurs when the heart doesn’t contract properly due to weakness in the heart muscle, which causes the ventricles to stretch. In the case of diastolic heart failure the heart contracts well, but is unable to relax properly, causing the muscles to thicken and harden.

Both types of heart failure render the heart unable to properly fill with blood, which can cause the blood to accumulate into the lungs, hands, abdomen, legs and feet. This “backing up” of fluid is often referred to as “congestion”, or congestive heart failure.

Symptoms of heart failure include:

-       shortness of breath with little exertion

-       weakness or fatigue with little exertion

-       difficulty sleeping

-       unfamiliar coughing

-       swollen/tender abdomen

-       loss of appetite

-       increased urination at night

-       swelling of feet and legs

The importance of early diagnosis and treatment of this condition can’t be overstated. Further, it’s critical to identify the underlying cause of heart failure in order to determine the best course of treatment, which can range from medications, to device implants to surgeries, depending on the severity of the condition.

We strongly encourage patients to take an active role in controlling their symptoms by taking their medication regularly, monitoring their weight, heart rate and blood pressure, following diet and exercise recommendations and managing stress.

Heart failure is a chronic, progressive condition; however, patients who proactively monitor their key symptoms and adhere to their treatment plans can drastically improve their outlook for the future.

Have you or someone you love been affected by heart failure? If so, please feel free to share your thoughts or questions with me in the comments.

Ventricular Assist Devices: Hope for the Broken-Hearted

HeartMate II® LVAD; reprinted with permission from Thoratec Corporation

Many of you are aware of the benefits of heart transplant in patients with advanced heart failure; however, another form of therapy has been quietly emerging as a viable option for patients suffering from this condition.

A ventricular assist device (VAD) is a battery-operated mechanical pump that helps a weakened heart pump blood into the body. Essentially, it takes over the pumping action of the heart and drives blood into the aorta (the large artery that extends from the left ventricle of the heart and into the abdomen) and throughout the body. The device resides both inside and outside of the body, and is operated by an electric motor powered by a battery pack. The controller and batteries are typically worn over the shoulder or around the waist.

In most cases, VADs offer a short-term solution for patients awaiting a suitable donor for a heart transplant, particularly if their medical therapy has failed or if they’ve been hospitalized with end-stage heart failure. According to the United Network for Organ Sharing, over 2,900 Americans are currently awaiting a heart transplant (43 of which are in Georgia).

However, in some cases patients turn to VADs as an alternative to a heart transplant. We refer to this as ‘destination therapy’, meaning that the LVAD serves as a permanent solution for patients with advanced heart failure. Patients who are not heart transplant candidates but who have severe heart failure often pursue this course of treatment.

Ventricular Assist Devices support the left ventricle (LVAD), the right ventricle (RVAD) or both simultaneously (biventricular, or BiVAD). LVADs are used most commonly, and have been in existence for over twenty-five years.

A recent study comparing a new generation LVAD to an older model showed a marked improvement in survival at 2 years (58% vs 25%). In addition, patients reported an improved quality of life. As a result the FDA approved the Heartmate II as destination therapy for patients with end-stage heart failure.

Despite the severity of their illnesses, 70-80% of LVAD patients survive to transplantation.

There are several different types of LVADs, and I’ll go into more detail about specific devices and technology that the Emory Heart and Vascular Center utilizes in a later post. You’ll also hear from two very special patients who have been kind enough to share their stories with us.

Do you have any questions or thoughts about VAD technology or heart conditions in general? If so, please share them with me in the comments.

About Sonjoy Laskar, MD:

Dr. Laskar joined Emory Healthcare in 2005 and has devoted his career to providing direct care to patients with heart failure, heart transplantation and ventricular assist devices, as well as to teaching residents and fellows. He is an active researcher in the areas of echocardiography and ventricular assist devices as destination therapy, and is a member of the American College of Cardiology, Heart Failure Society of America and the International Society of Heart and Lung Transplantation.