Procedures to treat heart failure are aimed at improving quality of life, decreasing hospitalizations and improving mortality in patients with advanced heart failure. Your doctor will provide you with more information about the risks and benefits of these heart failure therapies.
In patients with heart failure, a delay between the contraction of the right ventricle and the left ventricle often occurs. When this happens, the walls of the ventricles are unable to contract at the same time. This leads to an increase in heart failure symptoms, such as shortness of breath.
A special kind of pacemaker, called a biventricular pacemaker, is designed to treat the delay in ventricular heart contractions. It requires putting a pacemaker in the heart with an additional electrical wire (lead) that enables the left side of the heart (lateral free wall) to squeeze (contract) at the same time as the right side of the heart. The goal of a biventricular pacemaker is to help weak hearts squeeze blood properly and improve the symptoms of heart failure and the person's overall quality of life.
There are certain criteria that help define which hearts can benefit from a biventricular pacemaker. Most studies have required patients to be symptomatic, have weak hearts, and a wide QRS on the electrocardiogram (EKG). Studies, mostly involving men, demonstrate that this therapy can reduce symptoms of heart failure and the need for hospitalization, increase exercise tolerance, and increase survival 1-3. Although women are included in almost every study, the data is rarely analyzed to determine the benefit in women. One of the largest studies demonstrating a benefit (fewer deaths/hospitalization) in women is the COMPANION study which involved 493 female participants with weak hearts (left ventricular ejection fraction < 35%), moderate to severe symptoms (NYHA class III and IV), and a wide QRS (at least 120 ms) on the EKG. 1 The CARE-HF also analyzed the data for 215 female participants and noted that women benefited (fewer deaths/hospitalizations) from the usage of a biventricular pacemaker. 4
Patients with heart failure are at risk for abnormal heart rhythms which can lead to sudden cardiac arrest (SCA). SCA is responsible for 60 percent of deaths among mild to moderate heart failure patients. An implantable defibrillator (AICD) monitors the patient's heart rhythm, senses when these abnormal rhythms become life threatening, and delivers an electric shock that restores the normal rhythmic pattern. Since these devices can prevent death, we highly recommend the usage in women despite the fact that the current data does not clearly demonstrate a benefit because of wide confidence intervals and hazard ratios crossing 1.0. 1,2 More research needs to be done in this area and studies need to be designed prospectively for women.
Ventricular Assist Device (VAD)
A ventricular assist device (VAD) is a mechanical pump that helps weak hearts pump blood throughout the body. It is used as a "bridge-to-transplant" for those whose medical therapy has failed and are hospitalized with end-stage heart failure. It is also used for those with end-stage heart failure who are not candidates for transplantation (due to age or other co-existing medical conditions. This is called "destination therapy."
The surgery required to insert a mechanical device (ventricular assist device) to assist the failing heart is technically the same operation for men and women. The devices have minimum weight/height requirements in order to fit properly 1. Because women tend to be small their options may be more limited. Survival afterwards appears more dependent on the condition of the heart failure patient immediately preceding the operation than on gender. 2
Heart transplant surgery is a procedure to remove a damaged heart and replace it with a donor heart.
In the United States in 2005, women donated approximately 30% of the available hearts and received approximately 28% of the hearts transplanted 1
Current criteria for matching a heart is based on body weight (generally donor is within 20% of recipient's body weight), blood type (O, AB, A, B), and occasionally tissue typing (reserved for recipients with high anti-HLA antibodies).
Survival after heart transplantation is very similar between men and women recipients, but slightly worse for women (2% worse at 1 year and 3 years post-transplant 2), according to national 1) databases.
The international database 3 for heart failure indicates a higher one-year mortality for female recipients and a slightly higher risk if there was a donor/recipient mismatch (if a female recipient received a heart from a male donor). It remains controversial whether the gender of the donor (i.e. male or female donor) affects the survival of the female recipient. Most large studies suggest that women can receive a heart from either sex without it affecting survival 4,5.
Find a Cleveland Clinic heart doctor who specializes in heart failure in women
*a new browser window will open with this link. The inclusion of links to other web sites does not imply any endorsement of the material on the web sites or any association with their operators
written with Dr. Eileen Hsich, specialist in Women & Heart Failure