Advanced Heart Failure: Treatment options available for Stage 4 Patients
When can one know that they may be suffering from heart failure?
Ever experienced a sudden increase in your heartbeat or uneasiness when you are simply lying down? These are things that we may experience on a day-to-day basis but the moment you start noticing a pattern, it is time to consult an expert. These are common symptoms that a patient suffering from heart failure often experiences. Heart failure occurs when the heart’s ability to pump weakens, thereby hindering the flow of oxygen and nutrient rich blood to the body’s cells. This hampers the overall functioning of the body leading to challenges in carrying out daily routine activities. Heart failure is a progressive disease and when left untreated, can cause irreversible damage to the heart. While it is a serious condition which cannot be cured completely, the disease can be managed through medication, lifestyle modifications, procedures and therapies depending upon the stage of the disease. The advancement of medical technology has made it possible even for patients with end stage heart failure to lead a normal and good quality of life.
Different stages of Heart Failure:
According to the New York Heart Association Classification (NYHA Class 1-4), heart failure has 4 stages and the treatment varies at different stages. This is because once a patient has progressed to the next stage, it cannot be reversed i.e. once they progress to Stage C, they cannot go back to Stage B or A. The common symptoms of heart failure include chest pain, shortness of breath, irregular heartbeats, fainting or sever weakness, lack of appetite, nausea and swelling in ankles, feet and legs among others. On experiencing any of these symptoms, one must seek medical advice immediately. While in the initial stages, the disease can be managed with lifestyle and diet modifications and medications, in the advanced stages, these may not work.
Treatment options for advanced heart failure:
While an advanced heart failure patient has a variety of treatments available to them such as surgeries, implantable devices such as pacemakers and ICDs (implantable cardioverter defibrillator) and therapies, a heart transplant is often considered the only option in case of end-stage heart failure when the other options fail. However, undergoing a transplant is dependant upon some external factors which may be beyond our control such as the availability of a donor, increasing number of patients for transplants and the patient’s medical condition. In such cases, technologically advanced procedures such as LVADs can be a feasible alternative for patients. LVAD or left ventricular assist device is a battery-operated mechanical pump which helps the left and largest chamber of the heart pump blood. The long-term survival rate of LVADs is similar to that of a heart transplant and patients can live an improved quality of life post undergoing this procedure. Over time, with the advancement of technology, LVADs have become more affordable, effective and easy to use.
Treatment for heart failure in the Post-COVID World:
Covid-19, the worldwide pandemic has in its own way shifted the focus from patients awaiting a renewed chance to live through the gift of organ donation. A patient of mine was one such individual who was a diagnosed case of end stage heart failure awaiting a heart transplant. The pandemic hit the country, bringing organ donations to a grinding halt. Unfortunately, his disease progressed and as he got sicker with more time being spent on an ICU bed, waiting for a donor heart, the pandemic spiraled inexorably out of control.
The only option for him was an LVAD that has demonstrated outcomes that have matched and proven superior to survival after a heart transplant beyond 2 years after the surgery.
The LVAD was an option explained to the patient and family to stop the progression of the disease and get him back to health. He successfully underwent the 4-hour long procedure and was discharged in 2 weeks from the hospital.
Off the 50000 heart transplants required in the US and approximately a quadruple of that number in our country, the shortage of donor organs becomes the limiting constraint. An LVAD obviates this hurdle as it has limitless supply and better long-term outcomes than a heart transplant in the short and medium term.
While the above treatment procedures can go a long way in effective management of heart failure, one must complement these by undertaking measures to maintain and improve heart health. Taking medication on time as prescribed by the doctor, consuming a well-balanced and healthy diet, staying physically active, avoiding stress of any kind and being aware of the possible symptoms of heart failure also play an important role in living a strong and healthy life.
