Heart Failure Treatment

Heart failure, or congestive heart failure, is a long-term condition in which the heart isn’t working as well as it should. It is unable to pump blood efficiently enough to meet the demands of the body, which can lead to organ damage or a build-up of fluid in the lungs, legs and feet.

Heart failure can be life-limiting, and while it can’t be cured, it can be treated. The aim of heart failure treatment is to prevent it from getting worse and to slow its progression.

For many people, lifestyle changes and medication can treat heart failure successfully. For others, surgery may be needed. For patients with end-stage heart failure, a heart transplant may be required. The treatment prescribed will depend on many factors, including the type of heart failure and its cause.

Lifestyle changes

There are several modifications that can be made to a patient’s lifestyle that can prevent heart failure from getting worse and improve the overall health of the heart. These include:

• Eating a healthy, balanced diet
• Exercising more
• Maintaining a healthy body weight
• Quitting smoking.

Sometimes referred to as cardiac rehabilitation, medical teams work with patients to design personalized rehabilitation programs designed to improve cardiovascular health through exercise, education, and lifestyle changes. This is an essential part of recovery and long-term management of heart failure.

Nutritional counseling and weight management may also be offered, providing tailored advice on heart-healthy eating habits and weight management strategies to improve overall heart health and to reduce the burden on the heart.

Medications

Medication can reduce the symptoms of heart failure and prevent further damage to the heart. Medication is also given to treat the cause of heart failure. Many people will take several different medications to treat their heart failure.

The type of medication you are prescribed will depend on the symptoms you have, the severity of the heart failure and any other medical concerns. Medications may be adjusted and changed over time. Medications to treat heart failure include:

• ACE inhibitors: A first line treatment, these relax the blood vessels and help the blood to pump better. They also help to keep blood pressure under control.
• Beta blockers: Reducing pressure in the heart, Beta blockers help it to pump more effectively and manage blood pressure.
• Diuretics: These reduce the amount of excess fluid that may have built up round the body.
• Angiotensin-2 receptor blockers: These dilate the blood vessels, helping the heart to pump better.
• Digoxin: These slow the heart rate and help people with heart failure and atrial fibrillation when other medications haven’t controlled symptoms.
• I(f) channel inhibitors: These slow down the heart rate.
• Mineralocorticoid receptor antagonists: These stop our stress hormones from making heart failure worse.
• Sodium-glucose cotransporter 2 inhibitors (SGLT 2 inhibitors): Known to reduce the risk of hospitalization in heart failure patients.

Devices

A procedure to implant a small device may be recommended to monitor or control the heart’s rhythm. Implanted devices to treat heart failure include:

• Pacemakers: The device is implanted under the skin which monitors the heart’s rate and sends an electrical impulse to keep it beating at the correct rate.
• Cardiac resynchronisation therapy (CRT): A type of pacemaker that ensures the walls of the left ventricle are all contracting at the same time.
• Implantable cardioverter defibrillators (ICDs): For those with an abnormal heart rhythm, an ICD constantly monitors the heart’s rhythm, delivering a controlled shock when it beats too fast.
• CRT-Ds: Cardiac resynchronisation and defibrillation (CRT-Ds): Given to patients who need both.
• Pulmonary artery pressure sensors: For those with chronic heart failure, this sends blood pressure readings to a monitor which can be accessed by medical teams, alerting them to when medication needs adjusting.

Surgery

If other treatment options aren’t working, surgery may be needed to improve the function of the heart. The surgery offered will depend on many factors, such as overall health and the cause of heart failure.

Thankfully, heart surgery today is safer and more effective than ever before. Many minimally invasive and catheter-based procedures are availablethat are helping people with heart failure to live longer and fuller lives.

Types of surgery for heart failure include:

Catheter ablation: A minimally invasive procedure to treat abnormal heartbeats, a cause and symptom of heart failure. A thin tube (catheter) is inserted into a blood vessel, guided to the heart, and destroys the tissue that is causing abnormal electrical impulses.

Coronary artery bypass graft surgery: Offered to people with coronary artery disease, in which fatty deposits (plaque) block the arteries causing them to narrow or to become blocked. The surgery can be open or minimally invasive and involves placing a blood vessel from another part of the body above and below the blocked vessel.

Coronary angioplasty and stent: A minimally invasive procedure, also used to treat coronary artery disease, in which blocked arteries are opened. A catheter goes inside the affected blood vessel and a balloon is inflated to compress the plaque. Once the blockage is opened, a stent is put in place to hold the artery open permanently.

Heart valve surgery: Procedures either repair or replace damaged or diseased heart valves. The type of surgery offered will depend on the valve that is affected and its severity.

Ventricular assist devices: VADs are implanted devices that help the heart to pump blood properly from the lower chambers. Nowadays, VADs are smaller, more efficient and more durable than ever before, making them safer for patients.

• Left ventricular assist devices (LVADs) are placed in the left lower heart chamber. They may be given to patients waiting for a heart transplant or for longer term treatment.
• Biventricular Assist Devices: BiVADs support both sides of the heart and are given when both heart ventricles are failing.
• Fully implantable VADs: Emerging technology means fully implantable VADs are available, reducing the risk of infection from external components and improving quality of life for patients.

Heart transplant

A heart transplant is usually given to patients with end-stage heart failure. It is a major surgery in which the damaged heart is replaced with a healthy one from a donor.

The Heart Failure Program at Cleveland Clinic Abu Dhabi offers patients with heart failure a comprehensive range of treatment options, including the most advanced surgical treatment options available.