4 descubrimientos que están transformando el cuidado de la insuficiencia cardíaca

La salud del corazón

por Colaborador invitado

noviembre30,2023

Current estimates are that nearly 6.5 million Americans over the age of 20 have heart failure. Heart failure is a chronic, progressive condition. It occurs when the heart stops being able to pump properly. It doesn’t stop immediately, but, over time, it begins to slow and weaken, essentially falling behind on pumping blood to the parts of the body that need it when they need it.

Medication, together with altered diet and increased exercise, can often help improve the symptoms, but, at least for now, there is no cure.

That’s why pursuing advancements in patient care options — not just cures — for those with heart failure is such a strong focus for the cardiovascular team at Baylor Scott & White.

Advancing heart pump technology for heart failure patients 

In the field of heart failure, one of the biggest challenges is the shortage of hearts available for transplants. However, technological advancements have allowed for many individuals living with heart disease an opportunity to improve their quality of life.

“The best treatment for end stage heart failure is a heart transplant, but limited organ supply means that only a few people can receive a transplant, which is where Left Ventricular Assist Devices (LVADs) come in. These are surgically implanted pumps that help the left side of the heart do its job, which is pumping oxygenated blood to the body,” said Nitin Kabra, MD, a cardiologist at Baylor Scott & White Legacy Heart Center – McKinney. LVADs are often referred to as ‘destination therapy’, which means that people will choose it as treatment they'll rely on for the rest of their lives.

The journey of LVAD technology began back in the early 2000s, and now there are even better versions available that can offer more possibilities for heart failure patients. However, there are still challenges. “Our hearts have two parts: the left and the right side. The left side sends blood to the body and the right side manages blood going to the lungs. For people with LVADs, it's crucial that the right side of the heart works well. If it doesn't function properly, it limits the ability of the LVAD to work and their health is in danger,” said Dr. Kabra. 

While LVADs have made a big difference for left-sided heart failure, there aren't permanent pumps available for the right side of the heart. However, new research has found that temporary right ventricular assist devices (RVADs) can support the right side of the heart during the surgery and recovery process. The temporary support system functions like a crutch for the right side of the heart, helping it regain its strength following surgery.

“Research gives us some hope and shows that we can improve the chances of patients who have trouble with the right side of the heart after surgery. It tells us that if we provide good support during early recovery, it can make the healing process go more smoothly,” said Dr. Kabra.

Treating obesity related heart failure with semaglutide injections

The link between obesity and heart disease is well-established. Eating well and exercising regularly is a key part to maintaining a healthy heart and reducing your heart disease risk. For those already living with obesity and a type of heart disease known as heart failure with preserved ejection fraction (HFpEF), new research has shown that there is potential for specific medications, known as semaglutide, to improve patient well-being and functional capacity.

HFpEF is a specific type of heart problem where the heart does not effectively pump blood around the body. This causes problems such as feeling out of breath, tiredness and fluid build-up in the body.

A recent study found that weekly semaglutide injections can help people with obesity related HFpEF feel better and improve their daily activities. In the study, patients were able to exercise more, had less inflammation in their bodies and lost weight. These results suggest that semaglutide could be a helpful treatment for this type of heart problem.

“This study also shows that there may be a significant change in how healthcare professionals perceive and address the obesity type of those living with HFpEF, who seem to have a specific type of heart failure,” says Javed Butler, MD, president at Baylor Scott & White Research Institute and a co-investigator in the study. “These patients suffer from a lot of symptoms and inability to carry activities of daily living—newer therapies hold promise to improve how these patients cope with this disease. Further studies can show how this therapy may impact long term outcomes like risk of hospitalization or survival."

Advances in remote monitoring and ambulatory transitions in heart recovery

In the past, heart failure was only managed through hospital visits. But now, those diagnosed with early-stage heart failure or who have seen their cardiologist or primary care doctor for worsening symptoms like shortness of breath, can be managed through remote monitoring from their home. This type of approach is done using wearables or other devices that are implanted in an outpatient setting.

There have been significant advancements in remote monitoring in heart recovery. This is in addition to improved ambulatory transitions in heart failure, where individuals can receive a tailored, optimized treatment plan without having to be admitted to the hospital.

These implanted devices track an individual's heart pressures and transmit the information to healthcare providers in real time. These devices are inserted using a cardiac catheter in less than an hour, eliminating the need for patients to spend a night in the hospital. 

“These devices allow us to understand a patient’s baseline levels as they are going about their regular lives. We can detect any deviations or subtle changes from the heart’s optimal pressure range, allowing us to identify potential issues such as pulmonary congestion (fluid in the lungs) before symptoms arise,” said Jaime Hernandez-Montfort, MD, director of advanced heart disease, recovery and replacement program at Baylor Scott & White Clinic – Temple. “This is particularly crucial for patients suffering from heart failure as on some occasions they may not exhibit noticeable symptoms. When the device notifies us of a change, depending on the severity of the situation, we can schedule them for a phone, video or in-person clinic visit to further investigate.”

These remote monitoring platforms can be especially helpful to many people in rural areas, since they no longer need to travel long distances or as frequently to see their cardiologist or be far from their families for treatment. The platforms also can help prevent long-term admission or emergency department visits.

“It's an effective way for us to identify the disease early, monitor if medications are effective and ultimately keep patients out of the hospital,” said Dr. Hernandez-Montfort.

Continued progress in treating ATTR Amyloidosis

ATTR amyloidosis is a condition in which abnormal protein deposits (called amyloids) accumulate in the body. Once considered untreatable, there have been advancements with imaging techniques and less invasive diagnosis procedures that can identify the condition earlier for better treatment options.

  • Strain imaging using echocardiograms: Echocardiograms are ultrasound tests that create images of the heart. Strain imaging is a specialized technique used to measure how the heart muscles stretch and contract.

  • Cardiac MRI scans: Cardiac MRIs use magnets and radio waves to create detailed pictures of the heart's structure and function. 

  • Nuclear PYP scans: Nuclear PYP scans involve injecting a substance called technetium pyrophosphate into the body. This substance can help detect and visualize abnormal protein deposits in the heart, which is important for diagnosing ATTR cardiac amyloidosis.

The FDA has also approved four new medications intended to slow or potentially prevent the progression of disease and improve the quality of life for those living with ATTR amyloidosis.

“There will likely be more studies to expand the use of these medications in treating ATTR cardiac amyloidosis,” said Parag Kale MD, a cardiologist at Baylor Scott & White Heart and Vascular Hospital – Dallas and director at the Center for Cardiac Amyloidosis at Baylor University Medical Center. “I am excited about the options available to patients for a previously untreatable condition.” 

Learn more about advanced heart failure care and treatment options at Baylor Scott & White Health. 

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