The number of people with heart failure in India alone was projected to be between 1.3 million and 4.6 million in 2022. Consequently, it is important to comprehend both the nature of the condition and what transpires throughout heart failure’s latter stages, such as advanced heart failure.
Heart failure is a serious medical illness that affects millions of people worldwide and presents a major public health challenge. The number of cases reported annually in India has been continuously rising, raising concerns, especially among those under 65. When these conditions advance to a later stage, such as advanced heart failure, it becomes important to take advanced treatment with options such as heart transplantation and LVADs.
Understanding advanced heart failure
When people with heart failure continue to have significant symptoms that interfere with their everyday activities despite being on the highest tolerated dosages of evidence-based medical treatment, it’s known as advanced heart failure (HF). Due to the difficulty of doing daily activities like walking or climbing stairs, this condition considerably reduces quality of life. It’s crucial to keep in mind that as it impairs a person’s quality of life, it also has an effect on their psychological well-being by compromising their capacity for independent thought and action. Advanced heart failure can be caused by a number of factors, such as coronary artery disease, diabetes, hypertension, congenital heart disease, valve disease, heart attacks, and an enlarged or infected heart.
Treatment options for advanced heart failure
Heart transplantation remains the gold standard treatment for end-stage heart failure, offering the potential for a definitive cure and long-term survival. This surgical procedure involves the replacement of a diseased heart with a healthy donor heart procured from a deceased donor. Heart transplantation is indicated in patients with advanced heart failure refractory to medical and surgical therapies, with a limited prognosis without transplantation.
Left Ventricular Assist Devices (LVADs) are medical devices used to pump blood from the left ventricle of the heart to the rest of the body, particularly in people with heart failure. These devices, implanted surgically, pump blood through a mechanical pump in the chest, bypassing the weakened heart. LVADs can serve as a bridge to heart transplantation, permanent treatment for heart failure, or temporary recovery measures. With advancements in technology, LVADs have become more affordable, effective, and user-friendly.
Making the right choice
- Patient Eligibility: Heart transplant prospects may include younger, healthier individuals with fewer coexisting medical issues. On the other hand, an LVAD may be more advantageous for elderly patients or those with other significant medical conditions.
- Organ Availability: Many patients may have to choose an LVAD as a long-term option or depend on one while waiting for a transplant due to the restricted supply of donor hearts.
- Individual Preference and Lifestyle: Following surgery, patients’ lifestyles must be taken into account. Patients on transplants need immunosuppressive medications for the rest of their lives, and those on LVADs have to take care of the device’s upkeep and power supply.
Advanced treatment options, such as heart transplants and LVADs, have transformed the treatment and management of advanced heart failure and given patients with poor prognoses hope and better results. Optimising treatment outcomes requires a customised approach driven by patient-centred care and evidence-based practice, even if each modality has specific benefits and drawbacks. The future of cardiovascular medicine and the quality of life for patients everywhere depend heavily on continued research, innovation, and collaboration as we traverse the intricacies of advanced heart failure therapy.
The article is authored by Dr Rajneesh Malhotra, Vice Chairman & Head – CTVS, Max Super Speciality Hospital, Saket East Wing – Delhi.
