We are no longer in an era where heart failure is merely seen as an end-stage cardiac condition. We now recognize it as a complex, multi-system syndrome—one that begins silently, progresses unpredictably, and if not treated aggressively, can lead to devastating consequences.

🫀 Understanding the Modern Landscape of Heart Failure

Heart failure today is not just about a weak heart—it's about how the body compensates, how the lungs, kidneys, liver, and even the brain are affected. It spans across:

• HFrEF – Heart Failure with reduced ejection fraction

• HFpEF – Preserved ejection fraction, especially in diabetic and hypertensive populations

• Right Heart Failure

• Acute Decompensated Heart Failure

• And increasingly, Cardiogenic Shock

The spectrum has widened. And so must our approach.

🔍 Why Are We Seeing Heart Failure in Younger People?

We are diagnosing advanced heart failure even in patients in their 30s and 40s. Why?

• Rising prevalence of diabetes, hypertension, and obesity

• Undiagnosed congenital or valvular disease

• Post-COVID myocarditis and viral infections

• And perhaps most alarmingly, delayed referrals

This is why awareness, early diagnosis, and referral to heart failure teams are crucial.

💡 What Has Changed in Management?

We are now armed with powerful pharmacological and device-based therapies:

• ARNIs, SGLT2 inhibitors, and newer beta-blockers are improving survival

• CRT and ICD implantation have redefined long-term rhythm management

• Mechanical circulatory support, such as IABP, Impella, and ECMO, have changed how we manage shock

• And in select patients, Heart Transplantation remains the gold standard

At Rela Hospital, we offer all levels of heart failure therapy—from medication titration to mechanical support and transplant.

⚙️ ECMO: A Modern Lifeline

In the past, many patients in cardiogenic shock were considered too sick to save. Today, with ECMO, we can stabilize, oxygenate, and support organs until the heart recovers or until a transplant becomes possible.

We’ve successfully bridged several patients to transplant, and others to recovery, with our dedicated ECMO and heart failure unit.

🫁 Heart Failure and Lung Disease – A Deadly Duo

Many of our heart failure patients also develop pulmonary hypertension, lung congestion, or RV failure. This is where our Heart & Lung Team steps in—to assess candidacy for combined transplant, or dual support systems.

🌱 Looking Ahead – Transplant & Beyond

At Rela Hospital, we are proud to say we’ve performed high-risk mitral valve repairs, minimally invasive surgeries, and heart and lung transplants in even the most complex patients.

The future lies in:

• Personalized heart failure clinics

• Artificial hearts (VADs) becoming more accessible

• Telemonitoring & remote titration

• Genetic screening in idiopathic cardiomyopathies

🙏 Final Thoughts

Heart failure today is not a death sentence. It is a manageable, and in many cases, reversible condition—if diagnosed early and treated holistically.

I urge all clinicians, cardiologists, general physicians, and intensivists—refer early. Let's not wait for ejection fraction to drop below 20% before taking action. Let’s create a continuum of care—from diagnosis to transplant—and give our patients the full spectrum of hope.

Thank you all, and let’s continue to breathe new life into broken hearts.

Dr. Srinath Vijayasekharan
Senior Consultant – Cardiothoracic Surgery
Heart & Lung Transplant Surgeon
Rela Hospital, Chennai