Heart Failure Treatment

Advanced-Stage Heart Failure Treatments

Commonly Asked Questions

Below are questions people with advanced-stage heart failure and their caregivers often have. They can help you draw up your own list of questions for the cardiologist or healthcare team.

1. How does a cardiac resynchronization therapy (CRT) device work? Is it a good option for me?

A CRT device is a small, battery-operated device that stimulates the heart to make it beat more efficiently. If you suffer from advanced-stage heart failure, your physician may prescribe a CRT device for you.

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2. What are the benefits and risks of a heart transplant?

As with any major surgery, a heart transplant carries substantial risk. The most daunting risk is the body rejecting the donor heart. There is also a greater risk of infection because of the immunosuppressive drugs (drugs that weaken your immune system) that must be taken to prevent transplant rejection. And, as with any major surgery, there is a risk of bleeding. But many patients who have been successfully transplanted have gone on to live much longer, more normal lives than they would have without the transplant. Your cardiologist and surgeon will discuss benefits and risks with you prior to the procedure.

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3. If I am not eligible for a heart transplant, what are my long-term options?

Ventricular assist devices (VADs) are proving to be viable options for many advanced-stage heart failure patients. Clinical trials have shown that patients with advanced-stage heart failure can live longer and enjoy significantly improved quality of life compared with those being treated with optimal medical management (drug therapy) alone. After surgery, the major risks for VADs include infection, internal bleeding and device failure.

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4. What is a VAD? How does it work?

A VAD is an implantable, electrically powered (through a battery worn outside the body) heart pump, which is designed to help restore proper pumping function to a weakened or damaged heart. It works to improve blood flow in concert with your heart - it does not replace your own heart.

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5. What are some potential complications of ventricular assist device (VAD) surgery?

Complications of VAD surgery are similar to the potential complications of any open-heart surgery procedure. You will be asked to sign a surgical consent form prior to the operation, as well as a consent form for blood transfusions. Your surgeon will discuss potential risks and benefits with you prior to the procedure.

Possible serious adverse events include the following:

• Neurological problems (such as stroke)
• Infection
• Bleeding
• Device malfunction (pump replacement)
• Kidney and liver dysfunction
• Right heart failure
• Depression or anxiety
• Death

Click here for complete information about indications, contraindications, warnings, precautions.

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6. Can a VAD keep me alive long enough to wait for a donor heart?

One use of VADs is commonly called bridge-to-transplant. In this role, the device can help you regain organ function and improve physical conditioning while you wait for a heart transplant. Patients have been known to survive for more than two years (and some longer) on a VAD while waiting to be implanted with a donor heart.

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7. Will my insurance company pay for my VAD?

Some VADs are approved for coverage by the Centers for Medicare and Medicaid Services (CMS) (www.cms.hhs.gov) and many private insurance plans in certain facilities. Please contact your insurance provider for more specific coverage information, as policies may vary.

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8. Will I need to take any medications?

Other than pain medication after VAD surgery and your current regimen of heart failure medication, you may require only a low dose of blood-thinning drugs. Immunosuppressive drugs (drugs that weaken your immune system) commonly prescribed after a transplant are not necessary with a VAD. Many times, the medications that you've been taking for your heart failure can be reduced or discontinued. Your physician will re-evaluate your medications before you leave the hospital and will continue to monitor them after discharge.

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9. How will the VAD affect my daily routine?

VADs are designed to restore blood flow throughout your body, enabling you to breathe more easily and feel less fatigued. All of your organs will receive more blood than they did before your implant, and this will likely improve their function-you will likely feel less light-headed as you receive better blood flow to the brain, and your kidney function will likely improve as well. You should feel better overall and be able to resume most of your normal activities. However, VAD system components are not waterproof and must not be directly exposed to moisture.

People with a VAD must avoid: tub bathing, water sports, participating in vigorous activity or contact sports. Physical exercise is essential to help prevent the unhealthy effects of bed rest and inactivity. Your physician will set expectations in terms of what your activity level should be.

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