We also have one of the largest left ventricular assist device (LVAD) programs nationwide. These heart pumps can extend the lives of heart failure patients who do not qualify for heart transplant or are waiting for a transplant.
Advanced Heart Failure Program
Living with chronic heart failure, especially advanced HF, can be a challenging and discouraging prospect for many patients. At Houston Methodist, our team of cardiac specialists offers compassionate, expert care and support so patients have better survival rates and an improved quality of life, whether they’re experiencing Stage A, Stage B, Stage C or Stage D (end-stage) heart failure. Maintaining regular, consistent follow-ups with your care team is crucial for optimal treatment benefits. Our Advanced Heart Failure Program is a joint effort between the DeBakey Heart & Vascular Center and the J.C. Walter Jr. Transplant Center. It offers a multidisciplinary approach and personalized treatment plans to help high-risk patients manage their symptoms and prolong life expectancy.
Common Causes of Advanced Heart Failure
Heart failure can have many causes, including:
- Restrictive cardiomyopathy: when the ventricles become rigid and restrict filling
- Dilated cardiomyopathy: when the heart muscle becomes abnormally enlarged, thickened or stiff because of a variety of diseases
- Cardiac amyloidosis: when there are deposits of abnormal proteins (amyloids) in the heart tissue
- Hemochromatosis: a genetic condition that causes an iron overload that poisons organs, including the heart
- Sarcoidosis: in which there is growth of inflammatory cells in different parts of the body, including the heart
- Ischemic cardiomyopathy: weakening of the heart muscle that can occur as a result of coronary artery disease
- Heart valve disease: when one or more of your heart’s valves, which facilitate blood flow, fail to open or close properly
- Arrhythmia: an irregular heartbeat, particularly one that is hard to control
Types of Advanced Heart Failure
The types of advanced heart failure are characterized by ejection fraction, the percentage of blood pumped out by the left ventricle of the heart with every beat. This includes:
Advanced Heart Failure with Reduced Ejection Fraction (HFrEF)
Low ejection fraction, usually less than 40%, causing the left ventricle to weaken and pump less blood, also called systolic failure
Advanced Heart Failure with Preserved Ejection Fraction (HFpEF)
Also called diastolic failure, the ejection fraction is above 50%, but the heart remains too stiff to pump adequately
Advanced Heart Failure with Mid-Range Ejection Fraction (HFmEF)
Characterized by ejection fraction between 41-49%, with signs and symptoms of both HFrEF and HFpEF
Signs & Symptoms of Advanced Heart Failure?
Heart failure is typically considered advanced after conventional treatments stop working and symptoms occur with minimal or no activity. They may experience repeated hospitalizations, damage to organs outside of the heart, and other types of heart disease. Common symptoms of advanced heart failure include:Advanced heart failure symptoms include:
Shortness of Breath
Breathing difficulties are the most notable sign of advanced heart failure. Shortness of breath is progressive with AHF, worsening with activity or while lying down or resting. Patients may need to be propped up on a pillow to sleep, and may wake up gasping for air.
Fatigue
Tiredness with advanced heart failure is extreme. The fatigue causes severe weakness, which impedes patients from walking, moving around and completing daily activities like bathing or dressing.
Low Blood Pressure
Because the heart struggles to adequately pump blood through the body due to advanced heart failure, patients may experience low blood pressure or hypotension. This can cause additional weakness, fainting, dizziness and confusion.
Medication Intolerance
Many patients with advanced heart failure are unable to take certain heart medications, including beta-blockers, ACE inhibitors and ARNIs. Taking these medications during end-stage heart failure can drop blood pressure, cause serious falls or impede renal function.
Swelling
Swelling, or edema, of the arms and legs is common, especially for congestive heart failure (CHF) patients. Reduced heart function leads to fluid buildup, which can also impact the liver, lungs and gastrointestinal system. Congestive heart failure is often a result of coronary artery disease (CAD) or high blood pressure (pulmonary hypertension).
How Advanced Heart Failure Is Diagnosed
There are many tests that can confirm what stage of heart failure you may be in. If your doctor suspects advanced heart failure, he or she may use the following tests to determine a diagnosis:
- Blood tests: These are used to measure biomarkers that indicate heart failure.
- Cardiac catheterization: Measures pressure inside the chambers of the heart.
- Cardiac stress testing: Determines cardiac function at different levels of exertion.
- Echocardiogram: Used to measure the heart’s ejection fraction.
- Cardiac MRI: An imaging test that shows a detailed depiction of the heart.
- Nuclear imaging: A type of CT scan combined with nuclear imaging for 2D and 3D views of the heart.
- Cardiopulmonary exercise test (CPET): Determines how effectively your lungs, heart and muscles all work together while under exertion.
Treatment Options for Advanced Heart Failure
Non-Surgical Treatment Options
- Pharmacological management through the optimization of guideline-directed medical therapy (GDMT)
- Diuretic management and fluid restriction
- Heart failure infusion therapy using intravenous inotropes to strengthen the heart muscle
- Supportive palliative care, which provides relief from symptoms, pain and the mental and physical stress associated with a serious illness
- Hospice care and support for end-of-life decision-making
Surgical Treatment Options
While a heart transplant is the only surgical option that offers what might be considered a “cure” for advanced heart failure, there are other surgical treatment plans aimed at preserving quality of life for as long as possible.
- Optimization of your defibrillator or pacemaker, including cardiac resynchronization therapy (CRT), to improve breathlessness
- Consideration of a percutaneous valve, if a valve problem exists
- Consideration of using open heart surgery to open blocked arteries
- Mechanical heart, via a left ventricular assist device (LVAD) or artificial heart
- Implantable cardioverter defibrillator (ICD) to keep the heart rhythm consistent
- Heart transplant, as well as multi-organ transplant when needed
A Program Dedicated to Treating Advanced Heart Failure
When heart failure is advanced or difficult to manage, it’s best treated by a team of specialists that understands both the challenges of your condition as well as your unique needs.