Improving Quality of Life for Advanced Heart Failure Patients
As central Ohio’s largest heart failure program, Ohio State treats more than 2,000 patients and offers all treatments available, even for patients who have exhausted all other options.
“Most of the patients we see have advanced heart failure with persistent symptoms despite standard medical and device therapy,” says Garrie Haas, MD, director of Ohio State’s Heart Failure and Transplant Program. For those with severe heart failure, Ohio State performs implantation and follow-up care with total artificial heart pumps, ventricular assist devices (VADs) and heart transplantation.
With more than 400 heart transplants in over three decades, Ohio State remains central Ohio’s only adult heart transplant program. The transplant team performed 28 procedures last year with survival rates above the national average. The program continues to grow. Ohio State’s large and successful cardiac mechanical support program offers every available device option for patients who require advanced support for the heart. VADs are both a destination therapy and an important bridge to transplant, as they help sustain patients who are awaiting a heart donor.
Heart Failure Disease Clinic
Heart failure specialists and nurse practitioners work in collaboration with nurses, pharmacists, social workers and dietitians — all specialists in heart failure treatment — to provide both routine and acute care at Ohio State’s Heart Failure Disease Clinic. Care plans are tailored to the individual, including ongoing management of transplant patients.
“Our goal is to find out what works for each person and provide excellent, patient-focused care,” Dr. Haas states.
Treatment Options for Advanced Heart Failure
Ohio State’s advanced heart failure team works to exhaust noninvasive treatments before considering advanced therapies. If medication optimization, lifestyle changes and sleep apnea evaluation don’t yield satisfactory results, they evaluate for possible arrhythmias, and consider defibrillators, cardiac resynchronization and right heart catheterization to assess hemodynamics or candidacy for advanced therapies.
When appropriate, Ohio State’s heart failure specialists offer both inpatient and outpatient ultrafiltration for patients not responding to diuretics. Sometimes, high-risk surgeries and percutaneous interventions can improve low ejection fraction, coronary artery disease or structural heart disease. If these measures fail, the heart failure team considers VADs or heart transplant.
“We want to see people as early as possible in the disease process to provide optimal outcomes,” Dr. Haas says. “In the majority of cases, we can help improve the quality of life.”
Even if a patient is not ready for transplant, keeping the window of opportunity open for transplant is helpful. Ohio State’s specialists can work with referring physicians to plan for the possibility, mapping out a timeline and steps to ensure a patient’s health for transplant.
“In addition to providing the full spectrum of standard heart failure management, our program offers participation in a variety of clinical trials investigating novel drug and device therapies,” Dr. Haas says.
Ohio State’s researchers work diligently, often in collaboration with other disciplines, to improve treatment options. This includes new methods to increase the length of time a heart remains viable for transplantation. A new clinical trial is testing a device that removes excess fluid from hospitalized congestive heart failure patients. The WhiteSwell System, developed by study sponsor WhiteSwell Medical, includes a catheter inserted into the neck to improve the flow and drainage of fluid from the lymphatic system and a machine at the bedside that helps circulate blood.
A leader in another national study, Ohio State was first in the nation to implant the CardioMems wireless hemodynamic heart failure monitor in a patient, following Food and Drug Administration approval. The device is implanted in the pulmonary artery using a simple, catheter-based procedure. It takes real-time measurements of pulmonary artery pressure and transmits them to a secure website where cardiologists can review the data and make adjustments to medication, if needed.