Common Myths About Heart Failure Answered

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy!

Amanda Vest, MBBS:

Hello, my name's Amanda Vest and I'm a cardiologist specializing in heart failure and heart transplantation. I serve as the section head of heart failure and cardiac transplantation here at the Cleveland Clinic. And today, we're going to talk about a few myths that come up when people hear the word heart failure. There are some changes that can occur in the heart as we age. These are fairly subtle changes in structure and function and shouldn't cause people symptoms or to feel unwell. So if we have a weakness in the heart or a stiffness in the heart to the point where it starts to cause shortness of breath or other symptoms, that's not part of normal aging. That might be the condition of heart failure. And so it's not simply a wearing out of the heart. There's likely an abnormal process going on and something that we might be able to treat with medications, lifestyle recommendations, or other therapies.

Often, patients aren't quite sure between that terminology of heart attack and heart failure, what they specifically refer to. Heart attack or, as we doctors use the term myocardial infarction, means the situation where there's a blockage in the coronary artery. That's one of the small blood vessels that takes blood to the heart muscle. When there's a blockage in that heart's artery, it can cause chest pain, chest pressure, or other symptoms and can cause an area of the heart to not receive good blood supply. If the blood supply is not restored to that area very quickly, it may leave an area of damage and an area of weak pumping of the heart. Now that would be more consistent with heart failure. If there's a weakness of an area of the heart and it doesn't pump well, that could be a cause of heart failure. And heart failure is the condition of the heart being unable to meet the needs of the body resulting in symptoms which commonly include shortness of breath, especially on exertion, fatigue, and fluid retention. So they are quite different processes, although they can be linked with heart attack being a possible cause of future heart failure.

Unfortunately, heart failure can affect people across the spectrum of lifespan, so even babies and children can develop heart failure due to genetic abnormalities or congenital heart disease. Heart failure does become more common as we age, but still, a significant number of patients we see are in early adulthood. And there are many things that we can do to help those patients as well as those who present later in life. Often, patients will hear that one of the lifestyle changes might be to restrict the amount of fluid they drink, but truly, there are no good studies to tell us that this is beneficial for patients with heart failure. And it's very much a situation where recommendations should be personalized to the individual. What can be more important to recognize is that the water tends to follow salt that we ingest. So if one is taking in a lot of salt in the diet, then the water may tend to stick on the body more. Very severe fluid restrictions such as trying to drink less than one liter of fluid a day are rarely needed. So please do speak to your clinician if you have a question about fluid restriction.

We're learning a lot more about how the diet affects patients who have a diagnosis of heart failure. One of the biggest concerns actually is that malnutrition is common amongst patients who have heart failure. So it is very important that patients with a heart diagnosis such as this eat a good healthy diet with sufficient intake, especially of protein, to keep up their strength and muscle mass. Sometimes there may be restrictions recommended. So for example, for patients who have had difficulties with fluid retention, it may be recommended to keep lower on sodium.

And often in those situations, less than 2000 milligrams of sodium a day could be a recommendation that your clinician gives you. But even if looking to restrict sodium, it's still important that you eat well and take sufficient food every day to meet your body's needs. You should also speak to your clinician about whether there are any other recommendations around additional conditions you may have, such as diabetes or kidney disease that can be best managed with particular food choices. But overall, a diet such as the Mediterranean diet tends to be very heart healthy, minimalizes the intake of highly processed or fast foods, and really prioritizes fresh foods, including grains, fish, lean meats, vegetables, and fruits that can be very beneficial for your heart.

Often, patients are concerned that when they've received a diagnosis such as heart failure, that it may prevent them from doing the things that they enjoy. Every patient is an individual, so please talk to your care team about this. But overall, we really hope to get our patients with heart failure physically active again, and in fact, participating in physical activity, which for some patients might be a cardiac rehab program, which formally reintroduces activity can be very beneficial. For many of our patients, our goal is absolutely to get you back to playing sports or participating in the other physical activities that you've enjoyed in the past.

Heart transplantation is a very good option for patients who have the most severe forms of heart failure that isn't responding to other therapies, but that's only a fraction of our total population of patients with heart failure. For the majority of patients who have a heart failure diagnosis, there are lifestyle, medication, and in some cases, device or surgical therapies that can help them to feel better, live longer, and maybe get some improvement in the structure and function of their heart. So for most patients, it'll be lifestyle recommendations and their medications, which in this day and age are quite powerful tools for improving patient's heart function and symptoms. So many ways to treat heart failure that don't require as significant intervention as a transplant.

At the current time, it is still true that heart transplantation has better survival, particularly longer-term survival than the heart pump we can implant called a left ventricular assist device or LVAD. The average survival after heart transplantation in the United States is currently around 13 years, meaning half of patients who receive a heart transplant could live 13 years or more. And it's not uncommon for us to actually have patients surviving twentysomething, even thirtysomething years after a heart transplant. Now, unfortunately, we don't have survival in that type of duration for our patients who receive a left ventricular assist device, but with the most recent technology, so at the current time, the FDA approved pump is called a HeartMate 3 device. That technology is much more durable and associated with longer survival than some of the earlier pumps years ago.

So we do know that although heart transplantation has a three-year survival of about 85% in the United States at the moment, the MOMENTUM 3 study, which was the clinical trial of the HeartMate 3 device, had a survival at three years of 79%. So it would be fair to say that LVAD therapy is getting close to what we can achieve with transplantation, although currently doesn't have quite the survival outcomes as for transplantation.

One of the benefits of a left ventricular assist device or LVAD, is that actually, people of more advanced age may be able to benefit from an LVAD even if they're not able to benefit from a heart transplant. So it is actually fairly common these days for people in their seventies to receive a left ventricular assist device. And we are very used to supporting patients who are later in life on an LVAD device here at Cleveland Clinic.

I know it can sometimes be very overwhelming for patients to hear that multiple medicines may be necessary to treat their heart condition. But actually in 2024, we're in a good position in that we have several medications that we know each themselves contribute towards helping to heal a weak heart, improve how a person feels, and improve survival. In fact, for many patients with heart failure with reduced ejection fraction, that's a weak pumping function, you'll actually be recommended to take four medicines. Now in combination, these medicines are associated with quite impressive rates of recovery of the heart pumping function, of improvements in symptoms, helping to keep people out of the hospital and to live longer, healthier lives. So in fact, being given all the medicines that can treat your heart condition is a good thing. Please talk to your doctor or other care provider if you're not sure if you're on all the right medications or if you have other concerns about your medication recommendations.

So I hope some of these myths and my answers may have been useful to you. The truth at the moment is that we're in a position where many patients can benefit quite considerably from the lifestyle, medication, and maybe device and surgical options that are available to us for patients with heart failure. So please do speak to your clinician as to how we can best support you. And certainly here at Cleveland Clinic, we'd be very happy to be a member of your care team. We have a section of fantastic heart failure cardiologists who work very closely with our multidisciplinary team colleagues to provide care personalized to you. We have much expertise in some of the more unusual causes of heart failure. So you'll see listed on our website centers where we have particular subspecialty expertise, and so we'd like to help you with those conditions as well. And we work closely with cardiologists and cardiac surgeons across Cleveland Clinic to provide multi-specialty care tailored to you.

We look forward to being a part of your care team and helping you through this journey after a heart failure diagnosis. We appreciate it can be very daunting to hear those words and want to make sure that you understand what the implications are for you and how there are many things within your power that you can do to help feel better and to work with clinicians to identify the best therapy for your situation. So thank you very much and we look forward to seeing you here at Cleveland Clinic.

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