When Hearts Fail: The Latest Treatment Options

More than 2 million Americans have heart failure, and 400,000 new cases are diagnosed each year. Heart failure occurs when the heart loses its ability to pump enough blood through the body. It usually develops slowly, often over years, as the heart gradually works less efficiently.

At first, the heart hides the underlying problem by making adjustments that delay the eventual loss in pumping capacity. Eventually, however, the heart cannot offset the lost ability to pump blood, and the signs of heart failure -- including shortness of breath, fatigue, fluid accumulation and persistent coughing -- begin to appear.

Unfortunately, heart failure is becoming much more common. "As people increasingly live longer, and as obesity becomes more and more common," explains Allen Anderson, MD, director of the heart failure program at the University of Chicago Hospitals, "more people are developing heart failure." Patients are also surviving heart attacks better, and manifest with heart failure as a consequence.

For the common forms of heart failure -- those due to damaged heart muscle -- no known cure exists. But treatment can be quite successful. Most heart failure patients must take several medications. Those with acute symptoms take drugs that help them manage their fluid levels.

"A newer drug, called brain-type natriuretic peptide (hBNP), is increasingly used to get fluid levels under control," explains cardiologist Tony Kim, MD, who works with Dr. Anderson, "but long-term care still depends on some older standard drugs. These older drugs come in three categories. Angiotensin converting enzyme inhibitors decrease the pressure inside blood vessels. Beta blockers improve blood flow by relaxing the vessels. And inotropes increase the heart's sensitivity to the molecular signals that tell the chambers to contract."

Sometimes even drug therapy and lifestyle changes cannot control the symptoms. In such cases -- when there is a dramatic worsening of the heart failure and risk of impending death -- a heart transplant is often the best treatment. The University of Chicago Hospitals performed about 30 heart transplants in 2002, with very good success rates, making it the busiest program in the state. Although the Chicago program has had good fortune acquiring hearts for transplantation, with one of the shortest waiting times in the country, there are far more people nationwide awaiting transplants every year than there are donor hearts. Candidates for transplantation increasingly have to wait months or in some cases years before a suitable donor heart can found.

Transplant candidates who cannot wait sometimes receive mechanical pumps, a form of artificial heart called left ventricular assist devices (LVADs). These take over part or virtually all of the heart's blood-pumping activity. There are now several of these devices available. The heart failure team at the University of Chicago Hospitals has been the only site in the world for clinical testing of one of them, known as the Cardiovad, which is still experimental. Other LVADs have been approved for use as a bridge to transplantation and are being used more and more often as permanent treatment for heart failure.

Several established and experimental surgical procedures for severe heart failure are available at a few U.S. medical centers, including the University of Chicago Hospitals. A new device, called a bi-ventricular pacemaker, helps the two primary pumping chambers of the heart to beat together, increasing their efficiency.

Newer surgical approaches to treatment of heart failure are also being developed, such as novel methods for surgically removing non-contracting scar tissue, which can restore some of a damaged heart's pumping capacity. One of our surgeons has modified this technique to reconstruct scarred hearts with very good results in more than 100 patients. University of Chicago surgeons also helped develop an experimental mesh-like device that limits further dilatation of the heart and supports the swollen pumping chambers of the heart. This approach, called ventricular containment, prevents progressive enlargement of the heart thereby improving its function.

"We hope to begin a still newer approach soon, using stem cells," said Valluvan Jeevanandam, MD, chief of cardiac surgery at the Hospitals. "By transplanting these potent cells into the scarred area we may be able to regrow heart tissue, transform scar into beating muscular tissue, and restore some heart function."