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What Is Heart Failure?
Heart failure is a syndrome caused by conditions that limit the ability of the heart to supply blood to the rest of the body. Resulting symptoms are caused by a buildup of fluid or insufficient pumping function of the heart. Typical symptoms of heart failure include fatigue and inability to perform everyday activities, such as walking, climbing stairs, or carrying groceries. Symptoms of fluid accumulation include cough, shortness of breath, and swelling of the legs or abdomen.
The terms heart failure and congestive heart failure are often used interchangeably. Heart failure is now the preferred term, but it does not mean that the heart is about to “give out.” This condition has many different causes that result in abnormal heart function. Heart failure is a chronic progressive condition that worsens over time without proper treatment. It requires timely medical attention.
Heart failure makes it sound like the heart is no longer working. It simply means that the heart is failing to pump as well as it should.
Diagnosing and Treating Heart Failure
Someone hearing the term heart failure may think that the heart is no longer working. However, this condition doesn’t mean that the heart has “failed” and that nothing can be done. It means that the heart isn’t pumping as well as it should. Heart failure is the result of one of two issues:
- Insufficient pumping action of the heart, known as systolic heart failure
- Abnormal relaxation or stiffness of the heart, known as diastolic heart failure
The first type is also called heart failure with reduced ejection fraction. Our cardiologists abbreviate it as HfrEF, which is pronounced HEF-REF. The left ventricle loses its ability to contract normally, resulting in abnormalities in the circulation of the blood through the body.
Systolic heart failure has several possible causes. The most common is coronary artery disease, a narrowing of the arteries that supply blood to the heart. This narrowing limits blood flow to the heart muscle and can result in temporary injury to the heart muscle or permanent damage as a result of myocardial infarction (heart attack). Other common causes are long-standing and poorly treated high blood pressure (also called hypertension) and abnormal function of a heart valve.
The first step in the evaluation and treatment of systolic heart failure involves testing to determine the cause. Depending on the specific diagnosis, treatment often includes a combination of several medications. Each patient’s treatment will be different. There is a well-defined group of medications that have proven effective at helping patients feel better, preventing hospital stays for treatment, and prolonging life. It’s important for patients to take several different medications together because they work best in combination, better than any single medication by itself.
Effective treatment requires experience to prescribe the right medicines at the right doses in addition to close monitoring of the patient’s response to the medications. One of the newest treatments for patients with HFrEF includes medications called SGLT2 inhibitors. These medications were initially developed to treat diabetes and have now been shown to be very effective in treating heart failure.
Heart failure is a chronic progressive condition that worsens over time without proper treatment.
Many patients who have advanced heart failure may benefit from specialized pacemakers. For some patients, these devices may restore the normal coordination of heart muscle action, improving the heart’s function. Other patients may benefit from the placement of an internal defibrillator.
When patients who have HFrEF become seriously ill and do not show improvement with medication and pacemakers, they may require evaluation for placement of a left ventricular assist device, or LVAD. This is a mechanical pump that is implanted inside the chest to help the heart pump blood. These patients may also be considered for a heart transplant, based on general health, age, and ability to be involved in their own medical care.
Other patients with heart failure have a stiff heart” group, often called diastolic heart failure or heart failure with preserved ejection fraction (HFpEF, pronounced HEF-PEF). In patients with this condition, the heart’s main pumping chamber, the left ventricle, pumps normally but cannot fill properly with blood during the relaxing (or diastolic) phase.
These patients are as numerous as the first group and have similar symptoms; however, they have better survival than patients with HFrEF. Medical treatment for these patients is not as well defined, although there are some recent trials of medications that have shown great benefit in patients with HFpEF. In many cases, these patients also have other medical conditions that require careful treatment, including atrial fibrillation, diabetes, high blood pressure, and kidney disease.
Patients with heart failure can lead a full, enjoyable life when diagnosed early and managed with the right medications and healthy lifestyle changes.
Fredric Ginsberg, MD
Member of Cooper and Inspira Cardiac Care and Co-Medical Director of the Cooper Heart Institute
Every patient is different and many potential treatments must be considered depending upon the diagnosis. At Cooper and Inspira Cardiac Care, you’ll have access to a team of experienced multi-specialty doctors and healthcare professionals who work together — with you — to get the best outcome.
How and When Patients with Heart Failure Come to Cooper and Inspira Cardiac Care
Most cardiologists take care of patients with heart failure. Sometimes a cardiologist may be caring for a patient with heart failure whose condition is not improving or worsening, and they seek advice to prescribe the best medications. Many patients with heart failure require a combination of many medicines. It is not uncommon for a patient to take four to seven medicines for heart failure alone. We often provide consultations to optimize the medical therapies for heart failure. Many physicians care for patients with routine heart failure, but we may be consulted when additional care is required. Many patients with heart failure seek our care independently, and we often receive referrals from primary care physicians.
Both primary care physicians and cardiologists from the region refer patients to us when advanced therapies for heart failure may be required. Cooper is a highly specialized teaching hospital with extensive interventional and cardiac surgery experience. Patients are referred to us if they need advanced therapies for either coronary artery disease or valvular heart disease. If heart failure is caused by valvular heart disease, the patient may require cardiac surgery or interventions from our structural heart team.
A Connected Practice of Specialists
The treatment of a patient with heart failure may require multiple cardiac specialists. Cooper and Inspira Cardiac Care, with more than 30 cardiologists, provides our patients with a full range of experienced specialists. A patient with heart failure may need an invasive cardiologist to insert stents. A cardiac surgeon may be needed to repair or replace a damaged heart valve or perform coronary bypass surgery. A structural heart team may be needed to perform nonoperative mitral valve repair, called MitraClipTM, which is a procedure that is being performed with increasing frequency for patients with HFrEF.
Patients may require an electrophysiologist to implant a pacemaker or defibrillator. The electrophysiologist may be called on to treat arrhythmias with ablation techniques to help prevent further episodes of heart failure.
Every patient is unique, and all potential treatments must be considered. At Cardiac Partners, patients have access to specialized cardiologists who work as a team—with the patient—to get the best outcome.
In addition, our cardiologists share the patient’s electronic health records, so the entire team is knowledgeable about the patient’s medical history and can communicate easily and effectively. We also share an imaging storage system, so it is simple for the cardiologist to review the images from tests. For instance, our cardiologists can easily look at the images of an echocardiogram—not just the report, but the images themselves. Patients appreciate this capability—otherwise, they might have to carry the disc from their study from one doctor to another.
We also provide cardiac rehabilitation. Recent studies have shown that cardiac rehabilitation for patients with heart failure is valuable in improving outcomes. At each of our cardiac rehabilitation facilities, patients exercise under supervision three days per week and receive additional education on ways to help maintain good health.
Patient Involvement and Easy Access
Education for patients is vital. Patients with heart failure often take many medications, and they must determine a strategy and a system for taking their medications reliably and correctly. Their self-management often includes restricting fluid and salt intake and weighing themselves daily. This step is important because rapid weight gain is an early warning indicator of fluid accumulation.
We want patients with heart failure to have easy access to their cardiology team. If they get into trouble, they need to be able to communicate with a member of the heart failure team right away, either by phone call or email message. We always prefer to manage patients at home. Patients should not go to an urgent care facility or a hospital emergency department unless it is necessary.
Frequent office visits help patients to maintain a high level of function and can help to prevent complications. Patients are seen and treated by a cardiologist with expertise in heart failure, and the cardiologist works with an advanced practice provider (nurse practitioner or physician assistant), who assists the cardiologist in managing patients with heart failure. The patient’s primary cardiology team includes an advanced practice provider and a cardiologist, and they are readily available to answer all questions and offer assistance.
New Treatments Based on Research
We were one of 75 testing sites in North America and the only site in South Jersey to participate in a clinical trial called the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous for heart failure patients (COAPT). In this situation, the mitral valve leaks because the heart muscle is sick, not because something is intrinsically wrong with the mitral valve.
Fredric Ginsberg, MD, Director of Heart Failure Services at Cooper and Inspira Cardiac Care, who supported this trial states, “Following the MitraClip procedure, patients who have severe heart failure symptoms because of leaking of the mitral valve, called mitral regurgitation, may experience significant improvement in shortness of breath and fatigue.” The trial examined patients with HfrEF who had moderate or severe mitral regurgitation and who were receiving the best medical therapies. It showed that treating mitral regurgitation by clipping the mitral valve with a nonsurgical procedure resulted in improvement in symptoms and survival.
That trial was completed several years ago, and in 2019, MitraClip was approved for use in this group of patients with severe mitral regurgitation. Many of our patients have had this procedure and have done extremely well. Some patients have almost immediate relief of symptoms and feel significantly better within 12 to 24 hours.
New Capabilities Coming Soon
We are in the process of expanding our program for heart failure so that we will be treating all patients with severe heart failure with advanced heart failure therapies.
Soon, as we add new specialist cardiologists to our practice, we will have the capability to perform LVAD implantation. An LVAD may be used as therapy before high-risk heart surgery or heart transplantation. These devices can also be used as permanent therapy for selected patients.
At Cooper and Inspira Cardiac Care, We Are Here for You
Here in South Jersey, we treat many patients with heart failure. Even though it is a common cardiac condition, heart failure is a serious condition, with no cure. However, people with heart failure can lead a full, enjoyable life when the condition is diagnosed early and well managed with the right medications and healthy lifestyle changes.
If you are having symptoms, call to make an appointment so that we can diagnose and work together to manage heart failure. This is what we live for: to help you live your life to its fullest.
Recent studies have shown that cardiac rehab for heart failure patients helps promote improved outcomes.