Treatment options available for every stage of heart failure

Heart failure develops due to the gradual weakening of heart muscle resulting in a decreased ability of the heart to supply blood to the organs. Often it is confused with a Heart attack, which is a sudden stoppage of blood supply to the core. Currently, 8-10 million Indians are diagnosed with heart failure, and 1 million are added every year. It is alarming with a more than 20% mortality rate with people ten years younger than the global average.

Due to lack of awareness, heart failure is always thought of as a death sentence. Medical science has taken giant strides in the last decade especially in the previous three to four years. With the advancement of medical sciences, the management of heart failure, including advanced-stage heart failure, is possible.

Beat Heart Failure initiative by The Times of India in partnership with Novartis aims to spread knowledge about heart failure, its management, and the treatment options available at every stage of the disease. The leading doctors and founders of the Heart Failure program from Fortis Escorts Heart Institute, Okhla, New Delhi have supported the initiative.

Mr. Anil Vinayak, Group Chief Operating Officer, Fortis Healthcare said – “In order to identify, manage and treat heart failure, which affects a little over 1% of India’s population, mass awareness initiatives like this one are crucial. Cardiology & Cardiovascular Sciences is a Centre of Excellence at Fortis Healthcare and expert doctors at our facilities across the country offer treatments and care in line with international benchmarks. As knowledge partners in the Beat Heart Failure campaign, they have touched upon several minute aspects of heart failure – from medical management to surgical interventions, focusing on empowering people with easy-to-understand information.” The doctors who have joined the conversation from Fortis Escorts Heart Institute, Okhla, New Delhi”- 1. Dr. Z S Meharwal: Executive Director and Head – Adult Cardiac Surgery, Heart Transplantation & VAD Program 2. Dr. Vishal Rastogi: Additional Director, Interventional Cardiology & Heart Failure program https://fb.me/e/1VwZtk0d3 Dr. Meharwal mentioned that people suffering from the disease are unaware of heart failure. Heart failure occurs when the heart’s efficiency in pumping blood to the body’s organs and to itself declines. The insufficient supply of oxygen in the body causes a low cardiac output and gradually leads to heart failure.

Outlining the symptomatic progression of heart failure, he dwelt on the concept of segmenting patients into four stages based on the heart failure symptoms in line with the guidance of the New York Heart Association (NYHA) classification system: 1. In the first stage, the patient is asymptomatic but at high risk of developing heart failure, and if not managed on time, the patient may develop the disease. This category may include people with comorbidity and a family history of heart disease.

2. There is a slight limitation of physical activity in the second stage with evidence of the absence of heart failure symptoms.

3. In the third stage, there is a marked limitation of physical activity.

4. In the last stage, heart failure is advanced, and the patients have breathlessness, fatigue, swelling of the body, including conspicuous symptoms at rest. People in stage four need advanced heart therapy, including heart transplants.

Dr. Rastogi added that not all hope is lost when diagnosed with heart failure. At every stage of heart failure, different treatment options are available. He elaborated that end-stage heart failure has fifty percent or fewer chances of survival. Such patients have repeated admissions to hospitals, and medications that helped previously may not help now on account of the heart getting weaker and weaker.

As the heart becomes weak, cardiac cachexia is a common complication of Chronic Heart Failure. Patients with cardiac cachexia suffer from generalized loss of lean tissue, fat tissue, and bone tissue; the chances of survival of such patients are slim. Treatment options at this stage focus on making patients live longer and improving their quality of life.

Dr. Meharwal elaborated that a doctor recommends beginning treatment as soon as the diagnosis of heart failure is made even before visible symptoms, to prevent patients from advanced heart failure. Patients are expected to improve with the treatment administered. He explained with a tremendously optimistic outlook that treatment commences with medication, control of risk factors, cardiac rehabilitation, and using specific devices.

The two surgical options in end-stage heart failure are heart transplant and ventricular assist devices, which are considered when the patient’s condition does not improve with medication and various medical therapies. This is evaluated with meticulous planning.

Dr. Rastogi remarked that a heart transplant was not a viable option ten years ago. Nowadays, people are becoming aware of organ donation. He added that a sixteen-year-old boy and his family had lost all hope when diagnosed with end-stage heart failure and was admitted in ICU. Suddenly they got a call about a viable heart for the child. After undergoing the heart transplant, the child is healthy and plays football. A period of one year is required after the transplant for adjustment but a near-normal life can be resumed after a heart transplant.

Heart transplant surgeries are limited due to the low availability of organs. Only a deceased donor is available for a heart transplant and not living donors, as seen in kidney or liver transplants. The organ taken for transplant should be young, functioning well, and should be harvested before overall death. Patient hesitancy is also another reason for the lack of heart transplant surgeries. The day the patient gets a call for a heart transplant, they chicken out due to fear of the surgery. But they should understand that the risk of heart transplant surgery is 5-8%, but the risk of not having the surgery is a 50% survival rate in the next six months.

The heart has two atria and two ventricles. The left ventricle is the pumping chamber of the heart. The blood pumped by the left ventricle is transported to the aorta and then to the rest of the body. LVAD or Left ventricular assist device supports the left ventricle and pumps the blood to the aorta, reducing the natural heart’s burden, said Dr. Rastogi. If the right side of the heart is functioning normally and the left ventricle is damaged, LVADs are recommended by the surgeon.

LVADs are readily available, and the survival rate depends on the first three uneventful years. The majority of patients live an everyday life after LVAD and do not have any symptoms of heart failure. However, the patients should regularly get coagulation parameters checked.

Dr. Mehrawal also advised that Cardiac Rehabilitation is necessary post-cardiac surgery. It helps in strengthening the muscles and should always be done under medical supervision. Cardiac Rehab includes medical evaluation, physical activity, lifestyle education, emotional support, and positive communication. It can be done in hospitals, out-patient clinics, and even at home with tremendous results.

People should not lose hope after the diagnosis and should reach out to a heart failure specialist for help and guidance. The first step to treat heart failure is communicating clearly with the doctor. Heart failure is treatable and manageable at every stage.