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How have heart failure treatments improved over the past 20 years?

Dr. Ali Nsair, MD
Cardiologist (Heart Specialist)

We have made tremendous strides in treating heart failure over the past twenty years with medical therapies and devices. However, the best treatment remains prevention of heart failure by treating any risk factors when possible. That includes regular medical checkup to treat high blood pressure, high cholesterol or diabetes to minimize the risks associated with these conditions. As well, quitting smoking and a healthy life style to prevent significant weight gain is critical in decreasing the chance of developing a multitude of ailments that will lead to heart failure. 

We have developed a great deal of knowledge of the underlying biological causes and precipitants of clinical heart failure on a cellular level which has lead to the development of many medication such as Beta Blockers, ACE inhibitors and Aldosteone blockers that have dramatically improved the outcome of patients with advanced heart failure. As well, over the past two decades, specialized pacemaker therapies such as ICD (Implantable Cardioverter Defibrillator) and CRT (Cardiac Resynchronization Therapy) have significantly improved outcomes in advanced heart failure patients.

The field of mechanical circulatory support has been rapidly advancing over the last 20 years. These mechanical devices perform the heart’s pumping function for people whose own hearts have been irreversibly damaged; they can be used to keep someone alive while waiting for a heart transplant or as destination therapy for those who are not candidates for transplant to assist the patient’s heart when it has irreversibly failed. The number of patients receiving these pumps currently exceeds the number of patients receiving heart transplants due to availability of the pump, reduction in size and improvement in the technology of these very sophisticated pump assist devices.

And, finally, in heart transplantation remains a tremendous therapy for patients with end stage heart failure. This entails transplanting a healthy heart from a person who has agreed to be an organ donor at the time of their death, a tremendously generous thing to do. Our only limitation in heart transplantation is the number of donor organs and we encourage everyone to be an organ donor to help save the lives of many other patients who desperately need heart and other organ transplants.

Starting with the development in medical therapies, there has been a more complete understanding of what the dysfunction in heart failure is about—not only seeing it on the isolated organ level but taking the person as a complex, dynamic system and treating him or her accordingly.

The field of mechanical circulatory support has been rapidly advancing over the last 20 years. These mechanical devices perform the heart’s pumping function for people whose own hearts have been irreversibly damaged; they can be used to keep someone alive while waiting for a heart transplant or as destination therapy for those who are not candidates for transplant.

We have moved to more evidence-based, less-invasive types of assist heart pumps that are smaller and more durable and allow the patient much more freedom to move about.

And, finally, in heart transplantation, I think one of the most important advances is the introduction of noninvasive monitoring based on a simple genomic blood test. Not only does this expose patients to fewer of the invasive heart muscle biopsies, but now we are using this gene-expression profiling approach to safely reduce the dosage of immunosuppression therapy, thereby reducing side effects.

Heart failure creeps up on people and slowly steals their breath away. At first it's difficult to catch a breath while walking, mowing the lawn or carrying a heavy box. As the heart muscle becomes weaker or stiffer and pumps blood less and less efficiently, the lungs begin to fill with fluid, and people with heart failure find it harder and harder to breathe. Eventually they find it a strain to draw a breath even when they're sitting still.

Doctors have new treatment options for patients suffering from heart failure: left ventricular assist devices (LVAD), new drugs for renal complications and a multicenter intracoronary gene therapy trial known as CUPID (Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease).

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.