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Lifesaving Therapies for Heart Failure

How people with this serious condition may be able to live longer, healthier lives

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Thanks to advances in treatment and technology, patients who would have died from heart failure five years ago now have a shot at surviving and having a better quality of life, too. “There are more effective therapies than ever before,” says Clyde Yancy, M.D., chief of cardiology in the department of medicine at Northwestern Feinstein School of Medicine in Chicago.

This is good news for the 6.2 million adults who have the condition, which carries a life expectancy of around five years for those not yet in the advanced stage. And while better treatments are arriving, heart failure rates are rising. Between 2011 and 2017, for instance, deaths from heart failure jumped by a whopping 38 percent, with most occurring among people 65 and older, according to a study published in JAMA Cardiology. Experts say this increase is largely attributable to rising rates of obesity and diabetes, which lead to the condition. Plus, medical and technological advances have made it possible for people to live longer with heart disease, which can progress to heart failure.

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What a diagnosis means

Heart failure doesn't mean the heart has stopped working; rather, it occurs when the organ is unable to pump an adequate supply of blood and oxygen to the rest of the body. Without the needed supply of nutrients and oxygen that blood brings, cells all over the body suffer. Sufferers may experience symptoms such as fatigue during everyday activities; buildup of fluid in the body, including swelling in the feet, ankles, legs or abdomen, or weight gain; dizzy spells; persistent coughing or wheezing; confusion and impaired thinking; and increased heart rate or heart palpitations.

If you've been diagnosed with heart failure, ask your doctor if you're a good candidate for one or more of the following therapies. In some cases patients with heart failure may benefit from a combination of treatments.

Targeting blood sugar with SGLT2 inhibitors

Until recently, three classes of drugs were available to treat heart failure: ACE-inhibitors, beta-blockers and aldosterone antagonists. All were reasonably effective, but now a fourth class — SGLT2 (sodium-glucose co-transporter 2) inhibitors, which were designed for diabetics — is offering new hope for symptom relief, a better quality of life and longer survival, Yancy says. These drugs ease the burden on the heart by lowering blood sugar levels, eliminating blood sugar in the urine, reducing pressure on the kidneys and jump-starting weight loss, explains Deepak Bhatt, M.D., executive director of Interventional Cardiology Programs at Brigham and Women's Hospital in Boston.

One SGLT2 inhibitor, dapagliflozin, has been approved by the Food and Drug Administration (FDA) for patients with a weak heart, a common cause of heart failure. A weak heart can be caused by a heart attack, heart valve disease or a viral infection. Another common cause of heart failure is a stiff heart — the result of the organ's contracting normally but not relaxing properly, causing fluid to back up into the lungs. The FDA may soon approve other SGLT2 inhibitors for heart failure patients with weak and stiff hearts, Bhatt says.

Insurance typically covers SGLT2 inhibitors for diabetes patients. For heart failure patients without diabetes, coverage depends on the carrier.

Remote monitoring can decrease hospital stays

Heart failure patients who are hospitalized frequently or live in remote locations may benefit from advances in remote-monitoring technology. A sensor implanted in the pulmonary artery — the blood vessel that moves blood from the heart to the lungs — monitors pulmonary artery pressure and heart rate. If the pressure is too high, the sensor notifies the patient's hospital. “For the right patients, remote monitoring can decrease the need for frequent hospitalizations,” Bhatt says.

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This sensor will likely be the first of many heart failure monitors that measure pulmonary artery pressure and heart rate from afar, according to Bhatt. Remote monitoring is widely available at academic medical centers and large community hospitals that treat heart failure and is covered by some insurance companies.

Adding years with a left ventricular assist device

A left ventricular assist device (LVAD), a miniature pump that performs this function of the heart, may extend the lives of those with advanced heart failure. A multidisciplinary team of heart failure specialists meets to determine whether the patient could benefit from an LVAD or a heart transplant. If the team determines that an LVAD is appropriate, the device is implanted through open-heart surgery. The device can be left in place permanently, but if heart function recovers, it can be removed. In some cases an LVAD is implanted when a patient is waiting for a heart transplant. An LVAD is typically covered by insurance.

Unfortunately, this device can lead to serious complications, such as an increased risk of stroke, Bhatt says. In the near future, advances in LVADs are expected to decrease this risk. Also, in a few years there will likely be more minimally invasive implants.

What you can do

In addition to medication, lifestyle changes can increase your quality of life if you have heart failure. Among other changes, the American Heart Association recommends these:

  • Quit smoking. Nicotine temporarily increases heart rate and blood pressure, decreases the amount of oxygen circulating in the body and leads to stickiness of the blood vessels that feed the heart — all big negatives for those with heart failure.
  • Weigh yourself every day at the same time. Sudden weight loss or gain may indicate that your heart failure is progressing.
  • Lose excess weight. Carrying extra pounds forces your heart to work harder.
  • Eat a heart-healthy diet of fruits, vegetables, whole grains, low-fat dairy products, skinless fish and poultry, legumes and nuts. Limit salt; it contributes to unwanted water retention. And avoid trans and saturated fats that can cause your heart to have to work harder.
  • Monitor your blood pressure at home and report any changes to your doctor. Hypertension, plus obesity and diabetes, helped drive a 51 percent increase in the number of heart-failure deaths in adults under age 65 between 2011 and 2017, the JAMA Cardiology study showed. Many adults with heart failure will need to take several blood pressure drugs to keep hypertension under control.
  • Improve your sleep at night to keep your heart at its healthiest. Avoid long naps during the day and big meals before bed.
  • Know that flu and pneumonia are dangerous for people with heart failure, and talk to your doctor about getting vaccinations to ward them off.

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