You have heart failure: what does this mean?

Podcast Transcript

Announcer: Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart and Vascular 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.

Dr. Steve Nissen: I'm Dr. Steve Nissen and I'm here with Dr. Ed Soltesz, who directs the surgical LVAD and transplant program, and Dr. Jerry Estep, who heads up the medical side to our heart failure and transplant program. So, for patients that have been given a diagnosis of heart failure, often it seems just like a terribly grave diagnosis. Heart failure, it sounds terrible. What do people need to know about this diagnosis, Jerry?

Dr. Jerry Estep: I think first, and foremost, this is a diagnosis that's not benign. I mean, the failure certainly highlights that, but when you look at all comers, patients with an ejection fraction of less than 40% that have the signs and/or symptoms associated with the syndrome, shortness of breath or fatigue, at the four to five year mark, after the diagnosis, mortality rates, chances of dying are up as high as 40-50%. And so our job as clinicians, heart failure providers, is to alter that trajectory and certainly weighing in medical management, in some cases surgical management. And so I think it's important to understand the long-term prognosis and we try to tease out that prognosis, one, three, five-year, as best we can. But I think it's important for patients to know that this is a concerning diagnosis, but not all is not optimistic. There are treatment strategies that can be used and should be used that will improve upon the projected survival that can improve quality of life and that can keep patients out of the hospital.

Dr. Steve Nissen: Dr. Soltesz, when should somebody who's been given this diagnosis, when should they be seen by a center that has advanced therapies like mechanical devices to support the heart or even heart transplantation? What's the right time for a patient to get evaluated? Is it when they first get the diagnosis or ... Help people understand what it is they need to know.

Dr. Ed Soltesz: Well, I think heart failure is clearly, as Dr. Estep said, a very daunting diagnosis. It's sort of like being told you have cancer and you feel alone. But I think it's important to understand that there is help available. Centers like ours, where we have collaboration between our medical colleagues and our surgical teams are able to provide a very good opinion for you, tune-up medications. Medications can be used to support patients very nicely for many years with heart failure. But also, continued monitoring of each patient's condition individually, over the years, to determine when the next steps need to be taken and oftentimes we have many options available for patients. Anything from a heart transplant to a left ventricular assist device, which is a small pump that gets put into the tip of the heart, that helps the heart pump.

So there certainly are options. I think it's important for patients to work with their primary care doctor or their local cardiologist and ask for a referral for a second opinion to a center of excellence like ours that deals with advanced heart failure patients, just to begin the workup and to be certain that they are being carefully monitored.

Dr. Steve Nissen: These little pumps have gotten better over the years, haven't they?

Dr. Ed Soltesz: They have, they have. The new pump that we have is called the HeartMate3, left ventricular assisted device or LVAD, and this is actually a magnetically-levitated pump. It's sort of like those trains in China that fly on the track and don't even touch the track and go about 350 miles an hour. But this pump is amazing because it can be surgically implanted into the patient. We don't even stop the heart when we put it in. The patients are in the hospital for about 10 days afterward, while they learn how to use the pump. Patients, of course, need to take a blood thinner and they need to take Coumadin daily, and they have to take care of the driveline exits, the little cord that gets plugged to a power supply and a controlling device, much like you do with your phone.

Dr. Steve Nissen: Every night.

Dr. Ed Soltesz: But it's a tremendous opportunity for patients to feel almost perfectly normal.

Dr. Steve Nissen: How long can they go on the batteries that they carry?

Dr. Ed Soltesz: They can go a number of hours. It all depends on exactly individual patients, but many hours.

Dr. Steve Nissen: Many hours and then they recharge from time to time.

Dr. Ed Soltesz: Correct.

Dr. Steve Nissen: Can people have more than one of these things?

Dr. Ed Soltesz: Oh, yes.

Dr. Steve Nissen: So they can kind of swap them out and-

Dr. Ed Soltesz: That's correct.

Dr. Steve Nissen: ... You teach them all those things and how to do it. You know, it sounds like a very challenging thing, but having seen a number of these patients and seen now normal they live, it's really worth people understanding that this is a way of getting back much closer to being normal again. Yes, of course, you've got to pay attention to some things, but it really is a huge advance.

Dr. Ed Soltesz: Correct, absolutely.

Dr. Steve Nissen: Okay, well thank you both for this excellent educational information for patients that have advanced heart failure.

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