Heart Failure: Advances in Technology, Drug Therapies Help Manage This Serious Condition

Much of the confusion about the condition known as “heart failure” stems from its name. Heart failure does not mean the heart stops. It actually means that the heart is not pumping as well as it should be. With heart failure, the weakened heart can’t supply the body’s cells with enough oxygen- and nutrient-rich blood.

Heart failure is a serious condition, and there’s no outright cure. However, many people with heart failure lead full and active lives when the condition is managed with a range of available medications -- and when healthy lifestyle changes are adopted involving proper nutrition, weight management, being physically active and controlling risk factors. (Heart Failure Awareness Week is observed Feb. 12-18 to help increase education about the severity of this disease.)

Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program at Baptist Health Miami Cardiac & Vascular Institute. 

Moreover, advances in monitoring heart failure and treatment therapies continue to move forward, explains Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program at Baptist Health Miami Cardiac & Vascular Institute. Dr. Chaparro and the Institute are taking leading roles in clinical studies that will help heart failure patients in coming years better diagnose, treat, and manage their condition.

“Patients can be treated with medications, we have very effective therapies that actually improve the contractility of the heart,” said Dr. Chaparro. “That’s something that 10 years ago we didn't have. Most patients were chronic. Now, we have improvements of the ejection fractions from 10 percent to normal on some of the patients that tolerate heart failure medicines. So, a diagnosis of heart failure doesn't mean that you don't have options.”

Ejection fraction measures the amount of blood the left ventricle of the heart pumps out to your body with each heartbeat. An ejection fraction below 40 percent means the heart isn't pumping enough blood and may be failing. A normal ejection fraction is about 60 percent to 75 percent.

Diagnosing Heart Failure

Heart failure can be challenging to diagnose, which makes it vital for anyone with risk factors to seek medical attention and get tested for the condition.

“The problem is that heart failure is a syndrome,” said Dr. Chaparro. “It's not very specific in terms of the symptoms. Generally, symptoms can include weakness, headache, edema (swelling caused by excess fluid trapped in the body's tissues), and abdominal discomfort. As you can imagine, those symptoms can come from a variety of different diseases. So, you just need to have a high index of suspicion.”

The most common cause of heart failure is coronary artery disease (CAD), which occurs when arteries that supply blood to the heart muscle become narrowed by buildups of fatty deposits called plaque. Obesity, diabetes and high blood pressure are major risk factors for heart disease; however, those conditions can be modified and treated.

Faulty heart valves, damage to the heart muscles, and abnormal heart rhythm are other key risk factors. Survivors of heart attacks can also develop heart failure, which can be misdiagnosed or overlooked.

With heart failure, the heart makes two proteins, which are B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP). Levels of both of these in your blood go up when heart failure worsens, and goes down when it improves. A BNP blood test measures those two important levels. It’s able to spot heart failure more than 80 percent of the time.

“The BNP blood test will tell us how stretched the heart is, and the higher the number, the more stretched,” explains Dr. Chaparro. “That will give us an idea of how decompensated the heart is. It is one test for diagnosing heart failure. We also perform a physical exam, an electrocardiogram, and an echocardiogram. Those are the basic methods we use to diagnose the patient.”

Another advancement in treating heart failure are therapies to treat cardiac amyloidosis, a condition where faulty proteins build up in your heart. This condition can inherited or it can develop on its own, usually as you get older. As faulty proteins accumulate, the heart struggles to pump, ultimately leading to heart failure, and potentially death. However, this condition can now be diagnosed and treated to prevent heart failure.

“We now have different therapies for amyloidosis, a disease that was not recognized until recently,” said Dr. Chaparro. “It's a protein that is normally produced in the body, but in some people -- because they have some genetic mutation or because there's some issue either in the bone marrow or in the liver -- they produce more protein and it gets accumulated in the heart muscle. It makes the heart muscle very stiff. And that causes heart failure.”

Clinical Trials Aim to Improve Management of Heart Failure

Miami Cardiac & Vascular Institute was the first center in South Florida to implant a new sensor, the Cordella Pulmonary Artery Sensor System, in a heart failure patient that enables clinicians to better monitor and adjust therapy and medications remotely, without the need for additional office visits. Dr. Chaparro is on the steering committee for the trial.

The Institute is one of 90 U.S. centers taking part in the global clinical trial for heart failure patients using the Cordella Pulmonary Artery Sensor System to measure, record, and transmit pulmonary artery pressure and other vital data from home-based patients to their clinicians. Initial findings are promising, the trial is expanding, and results will start being released in 2023.

The Institute is also one of the U.S. centers to take part in the AIM HIGHer Clinical Trial to evaluate the safety and efficacy of “cardiac contractility modulation (CCM) therapy” in patients with heart failure and an ejection fraction of 40 percent to 60 percent. CCM involves an electrical stimulation treatment through an implant for symptomatic heart failure patients. The trial’s Optimizer pulse generator is easily implanted and it’s the first-approved CCM device for the treatment of moderate to severe chronic heart failure in patients who are at risk despite medical treatment.

“It's a unique technology that actually stimulates the heart in a different way than other systems available,” explains Dr. Chaparro. “We are enrolling patients who have higher ejection fraction, since it's only commercially available for patients with low ejection fraction. Patients graded at 40 percent of ejection fraction or higher will be enrolled in the clinical trial to see if we can improve their heart failure.”

When it comes to evolving technology and heart failure, there is also a voice-recognition application which may be able to detect decompensated heart failure, which is when heart failure has become severe and requires immediate medical attention. It can develop in people with preexisting heart failure and those without signs of the condition.

The HearO monitoring application samples the patient’s speech and makes an analysis compared to a baseline created for the patient. It measures specific differences, which may signal a risk to the patient’s health. Once identified, life-saving measures can be taken.

“It's basically an app that the patient downloads and it recognizes changes in the voice when the patient has more fluid,” said Dr. Chaparro. “The patient has to read every morning a sentence, and the app uses artificial intelligence with a specific algorithm to predict when that patient is going to have heart failure decompensation. At this point, we're not predicting when the patient is decompensating, but we're learning.”

While treating and managing heart failure has advanced significantly, the most important takeaway for everyone is that this serious and potentially deadly condition can be prevented by managing risk factors including coronary artery disease, obesity, hypertension (high blood pressure), tobacco use, and lack of physical activity.

“Always know your numbers -- cholesterol, blood pressure, hemoglobin A1C (blood sugar),” said Dr. Chaparro. “And, obviously, you need follow up with the primary physician who prescribed your blood tests and can guide you to prevent heart failure.”