We are living in an era where heart failure is no more considered as an end stage cardiac disease. Instead it is now considered as a multi-system syndrome, ranging from the initiation of the disease process to end stage cardiac dysfunction. It is a multi-factorial, multi-system disease process which if not aggressively tackled may lead to dire consequences.
Heart failure is now recognized as a multi-system disease process and the spectrum of disease goes from:
HFrEF – Heart failure with reduced ejection fraction
HFpEF – Heart failure with preserved ejection fraction (commonly seen in diabetic and hypertensive population)
Right sided heart failure
Acute decompensated heart failure
And cardiogenic shock
Therefore the spectrum of disease is very wide ranging from very mild to very severe.
We are seeing heart failure in the third and fourth decade of life due to reasons like
Increasing prevalence of diabetes and hypertension
Valvular heart disease
Myocarditis and post covid complications
And most importantly lack of early referrals.
Therefore raising the index of suspicion, early diagnosis and prompt referral to a heart failure team is of utmost importance
We have a myriad of pharmacological and device based treatment options for heart failure and we are now able to manage patients with chronic heart failure very effectively with agents like ARNI’S, SGLT 2 inhibitors etc., We are also able to manage arrhythmias very effectively with cardiac resynchronisation therapy and implantable cardioverter defibrillators.
Furthermore, we are able to provide very good support to patients suffering from cardiogenic shock with devices like IABP, Impella etc., In addition to that we have options like Heart transplant as a definitive treatment option. At Rela Hospital, we have an array of treatment options for patients with heart failure at all levels of management.
Previously patients with cardiogenic shock were considered as lost causes but with the advent of ECMO we are able to provide very good supportive care to these patients till their heart recovers or till we are able to get them fit for a heart transplant. We have a separate ECMO and heart failure intensive care unit at Rela hospital and have been able to successfully bridge a lot of patients with this life-saving procedure.
A lot of our patients with heart failure also develop lung related complications like pulmonary hypertension, congestion etc., In some patients the right ventricle also gets involved leading to right sided heart failure. We have a team of cardiothoracic surgeons, pulmonologists and intensivists who closely manage these patients and decide if they are candidates for a heart and lung transplant or combined heart lung support devices.
Rela hospital Chennai has been doing high risk mitral valve repairs, minimally invasive surgeries and heart and lung transplants, heart transplants in extremely difficult situations. We aim to develop heart failure clinics in future and be able to follow up patients on a very regular and distant basis with titration of their various medications remotely. We also expect that artificial hearts will soon become a part of clinical practice. Genetic testing may also help in future to determine patients at risk for idiopathic cardiomyopathies
Heart failure is no more a death sentence and is a disease which if tackled on time can be cured completely. I would like to appeal to my fellow clinicians across the globe to refer patients with a suspicion of heart failure to a heart failure team at the earliest. Let us not target an ejection fraction of less than 20% to refer a patient with heart failure because that is when it is too late. We need to have end to end care for patients with heart failure from a heart failure team and give them all the treatment options available to us at this point in time. I hope we are able to make a difference in the lives of patients with heart failure, till then I leave you all with this beautiful quote ” The heart is a small muscle but it has the strength to do incredible things.
Thanking you all and I hope to see you soon. Have a great day.
Dr. Srinath Vijayasekharan
Senior Consultant – Cardiothoracic surgery
Heart & Lung Transplant surgeon
Rela Hospital, Chennai
