Due to a lack of awareness, heart failure is still considered a death sentence. Medical science has made leaps and bounds in the past decade, especially in the previous three to four years. With the advancement of medical sciences, the management of heart failure, including advanced heart failure, is possible.
Mr. Anil Vinayak, Group Chief Operating Officer, Fortis Healthcare said: “In order to identify, manage and treat heart failure, which affects just over 1% of the Indian population, mass awareness initiatives like this are crucial.
Doctors who joined the conversation from Fortis Escorts Heart Institute, Okhla, New Delhi”-
1. Dr ZS Meharwal: Executive Director and Head of Adult Cardiac Surgery, Heart Transplantation and VAD Program 2. Dr Vishal Rastogi: Additional Director, Interventional Cardiology and Heart Failure Program https://fb.me/ e/1VwZtk0d3
Dr. Meharwal mentioned that people suffering from the disease are unaware of heart failure.
Heart failure occurs when the heart’s efficiency in pumping blood to the body’s organs and to itself decreases. Insufficient supply of oxygen in the body causes low cardiac output and gradually leads to heart failure.
Describing the symptomatic progression of heart failure, he dwelt on the concept of segmenting patients into four stages based on symptoms of heart failure according to the guidelines of the New York Heart Association (NYHA) classification system :
1. In the first step, the patient is asymptomatic but at high risk of developing heart failure, and if not treated in time, the patient may develop the disease. This category may include people with comorbidity and a family history of heart disease.
2. There is mild limitation of physical activity in the second stage with evidence of no symptoms of heart failure.
3. In the third stage, there is a marked limitation of physical activity.
4. In the last stage, heart failure is advanced, and patients experience shortness of breath, fatigue, body swelling, including obvious symptoms at rest. People in stage four need advanced heart therapy, including heart transplants. Dr. Rastogi added that all hope is not lost when heart failure is diagnosed.
At each stage of heart failure, different treatment options are available. He clarified that end-stage heart failure has a fifty percent or less chance of survival. These patients have repeated hospital admissions, and drugs that helped before may not help now, as the heart becomes increasingly weaker.
When the heart weakens, cardiac cachexia is a common complication of chronic heart failure. Patients with cardiac cachexia suffer from generalized loss of lean tissue, fatty tissue, and bone tissue; the chances of survival for these patients are slim. Treatment options at this stage are aimed at extending patients’ lives and improving their quality of life.
Dr. Meharwal clarified that a doctor recommends starting treatment as soon as the diagnosis of heart failure is made even before the symptoms are visible, in order to prevent patients with advanced heart failure. Patients are expected to improve with the treatment given. He explained with an extremely optimistic perspective that the treatment begins with medication, control of risk factors, cardiac rehabilitation and the use of specific devices.
The two surgical options for end-stage heart failure are heart transplantation and ventricular assist devices, which are considered when the patient’s condition does not improve with medications and various medical treatments.
This is assessed with careful planning.
Dr. Rastogi pointed out that a heart transplant was not a viable option ten years ago. Nowadays, people are becoming aware of organ donation. He added that a sixteen-year-old boy and his family lost hope when they were diagnosed with end-stage heart failure and admitted to intensive care. Suddenly they received a call about a viable heart for the child. After undergoing the heart transplant, the child is healthy and plays football. A period of one year is necessary after the transplant to adapt, but an almost normal life can be resumed after a heart transplant.
Heart transplant surgeries are limited due to the low availability of organs. Only a deceased donor is available for a heart transplant and not living donors as seen in kidney or liver transplants. The organ harvested for the transplant must be young, functioning properly and must be harvested before overall death. Patient hesitancy is also another reason for the lack of heart transplant surgeries. The day the patient receives a call for a heart transplant, he chickens out for fear of surgery. But they must understand that the risk of heart transplant surgery is 5-8%, but the risk of not having the surgery is a 50% survival rate in the next six months.
The heart has two atria and two ventricles. The left ventricle is the pumping chamber of the heart. The blood pumped by the left ventricle is transported to the aorta and then to the rest of the body. The LVAD or left ventricular assist device supports the left ventricle and pumps blood to the aorta, reducing the heart’s natural load, Dr. Rastogi said. If the right side of the heart is functioning normally and the left ventricle is damaged, LVADs are recommended by the surgeon.
LVADs are readily available and the survival rate depends on the first three years without incident. The majority of patients live a daily life after LVAD and have no symptoms of heart failure. However, patients should have coagulation parameters checked regularly.
Dr. Mehrawal also indicated that cardiac rehabilitation is a necessary post-cardiac surgery. It helps to strengthen muscles and should always be performed under medical supervision. Cardiac rehabilitation includes medical assessment, physical activity, lifestyle education, emotional support and positive communication. It can be done in hospitals, outpatient clinics and even at home with extraordinary results.
People should not lose hope after diagnosis and should contact a heart failure specialist for help and advice.
The first step in treating heart failure is to communicate clearly with the doctor. Heart failure is treatable and manageable at every stage.
Remember that heart failure is not about stopping. It’s about starting life in a new way. To learn more about managing heart failure, visit https://www.toibeatheartfailure.com/blog
(Disclaimer: “The views and opinions expressed in the article by the panelists/experts are based on their independent professional judgment and are being disseminated in the public interest. These views should not be considered a substitute for advice professionals from a licensed physician. The purpose of this article is not to promote any medical procedures or medications and/or to recommend a certain physician. For any specific health concerns, please consult with your licensed physician.”)