Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s requirements. It results from any disorder that impairs ventricular filling or ejection of blood to the systemic circulation.
As age takes its toll on humanity and cardiovascular disease incidents rise, one can anticipate an increase in its prevalence.
Key Stats
- Heart disease remains the leading cause of death in the United States, accounting for 928,741 deaths in the year 2020.
- One person dies every 33 seconds in the United States from cardiovascular disease.
About 695,000 people in the United States died from heart disease in 2021—that’s 1 in every 5 deaths. - Your chance of developing heart failure increases if you are 65 years old or older.
In this article, we aim to go through the existing treatment options for heart failure – highlighting medication-based treatments against implantable devices.
Heart failure implies that the heart is no longer working at all. Heart failure, often known as HF, occurs when the heart does not pump as well as it should. Congestive heart failure is a kind of heart failure that necessitates immediate medical intervention, and the two phrases are occasionally used interchangeably
The heart’s pumping motion is essential for delivering oxygen- and nutrient-rich blood to the body’s cells.
The weaker heart cannot give enough blood to the cells in heart failure. This causes weariness and shortness of breath, and some patients cough excessively. Walking, climbing stairs, and carrying groceries can all become quite tough.
Symptoms and Causes
Heart failure symptoms include:
- Shortness of breath.
- Waking up short of breath at night.
- Chest pain.
- Heart palpitations.
- Fatigue when you’re active.
- Swelling in your ankles, legs, and abdomen.
- Weight gain.
- Need to urinate while resting at night.
- A dry, hacking cough.
- A full (bloated) or hard stomach.
- Loss of appetite or upset stomach (nausea).
You may experience minor symptoms of congestive heart failure or none at all. This does not mean you are no longer suffering from heart failure. Heart failure symptoms can range from mild to severe and may come and go.
Congestive heart failure, unfortunately, frequently worsens over time. As the condition progresses, you may have more or different indications or symptoms.
Causes of congestive heart failure include:
- Coronary artery disease and/or heart attack.
- Cardiomyopathy (genetic or viral).
- Heart issues present at birth (congenital heart disease).
- Diabetes.
- High blood pressure (hypertension).
- Arrhythmia.
- Kidney disease.
- A body mass index (BMI) higher than 30.
- Tobacco and recreational drug use.
- Alcohol use.
- Medications such as cancer drugs (chemotherapy)
The most common cause of right-sided heart failure is left-sided heart failure. When your left ventricle isn’t operating properly, blood can back up. This backup eventually affects your right ventricle. Other factors include specific lung disorders and organ abnormalities.
Medication-Based Treatment
The goal of heart failure treatment is to help you live a healthier, longer life. Medication for heart failure can reduce fatigue, shortness of breath, and swelling. It also boosts your energy levels, allowing you to be more physically active.
Even if you have no signs or symptoms, medications can stop or decrease the progression of the disease. Patients suffering from heart failure may require various drugs. Each one is designed to cure a certain symptom or contributing factor and comes with its own set of instructions and guidelines.
Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors lower blood pressure by widening blood vessels. This reduces the workload of the heart and helps keep heart failure from getting worse.
Angiotensin-receptor neprilysin inhibitors (ARNIs)
ARNIs are a drug combination of a neprilysin inhibitor and an ARB. Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. Limiting the effect of neprilysin increases the effects of these substances and improves artery opening and blood flow, reduces sodium retention, and decreases strain on the heart.
SGLT-2 Inhibitors
Sodium-glucose cotransporter-2 inhibitors improve blood glucose control and decrease body weight and blood pressure. This drug class was developed to treat diabetes, but it has been found to help people with heart failure.Â
Hydralazine and isosorbide dinitrate
These medications widen blood vessels. When blood vessels widen, blood flows more easily and the heart doesn’t have to work as hard.
Implantable Devices: The Future of Heart Failure Care
Implantable devices have been used to treat heart problems for decades. Over 40 years ago, the first pacemaker was implanted, and implantable defibrillators were initially utilized in the early 1980s.
However, in recent years, there has been an increase in both the types of devices being tried for heart failure treatment and doctors’ optimism about their utility.
While technological advancements are amazing, experts unanimously agree that we are still in the early stages of their growth. It remains to be seen how broadly and swiftly these life-saving implants will be used in the treatment of heart failure.
Medical Devices for Treating Heart Failure
ICDs are implantable medical devices that monitor the heart’s rhythm and give electrical shocks to cure potentially fatal arrhythmias like ventricular tachycardia or ventricular fibrillation. By restoring a normal heart rhythm, they can avoid sudden cardiac death.
ICDs continuously monitor the electrical activity of the heart. They can provide an electric shock (defibrillation) to restore a normal rhythm if they detect an aberrant beat. Some ICDs can also function as pacemakers in the treatment of slower cardiac rhythms.
CRT devices, often called biventricular pacemakers, are used to treat heart failure, especially in patients with dyssynchronous heart contractions. They help improve the heart’s pumping efficiency by coordinating the contractions of the left and right ventricles.
CRT devices deliver electrical signals to both the left and right ventricles of the heart to synchronize their contractions, thus improving overall heart function.
LVADs are mechanical devices implanted in patients with severe heart failure to assist the left ventricle in pumping blood throughout the body. They are sometimes used as a bridge to transplant or destination therapy for those who are not eligible for heart transplantation.
An LVAD is typically implanted to help the weakened left ventricle by taking over a portion or the entirety of its pumping function. Blood is drawn from the left ventricle and pumped through the LVAD to the aorta, providing vital support to the circulatory system.
Efficacy and outcomes of Medication vs. Implantable devices
The efficacy and results associated with both pharmacological therapies and implanted devices are critical in the field of heart failure management. Traditionally, medication-based treatments have been prioritized, particularly those classified as pharmacy-based medications.
Prolonged use of particular heart failure drugs such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics has shown significant efficacy in reducing hospitalizations and improving patients’ health-related quality of life.
Nonetheless, while these medications are consistently effective, they frequently need strict adherence to dosages and timetables, which can be difficult at times, producing a disruption of inadequate therapy.
Conversely, the emergence of implantable devices has instigated a radical shift in how heart failure is managed. Innovative tools like Implantable Cardioverter-Defibrillators (ICDs) and Cardiac Resynchronization Therapy (CRT) have brought about an upheaval in therapeutic strategies.
Their focused operational methodologies paired with embedded remote monitoring capacities offer personalized care that remains uninterrupted.
Therefore, it appears that although traditional medicines maintain their crucial role in treatment; future trends seem inclined towards embracing such pathbreaking technology.
Conclusion
Devices like LVADs may offer a glimpse into heart-failure treatment for end-stage disease in the future. While stories about fully artificial hearts tend to grab headlines, such devices have limited use at this point.
LVADs, which use technology to supplement the heart’s natural function, maybe a more realistic approach in the near future.
Although devices are sometimes compared unfavorably with drugs because of their costs, many experts consider it a misleading comparison. Instead, devices and drugs may work together for heart failure treatment solutions.
References
- https://www.cdc.gov/heartdisease/facts.htm
- https://professional.heart.org/en/science-news/heart-disease-and-stroke-statistics-2023-update
- https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure
- https://www.webmd.com/heart-disease/heart-failure/features/heart-failure-treatment-by-device
- https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure
