Advanced Heart Failure Guide

Advanced Heart Failure, VAD, and Transplant

We offer leading-edge treatments to help patients with advanced heart failure live longer, healthier lives.

If you suffer from advanced heart failure, your heart muscle has become too weak, thick, or stiff to pump enough blood to meet your body’s needs. You may experience symptoms such as extreme fatigue, shortness of breath, fluid retention, poor sleep, heart palpitations, nausea, and/or weight loss.

At UT Southwestern, we’re at the forefront of using innovative medical and surgical treatments to extend and improve the lives of people who have run out of other treatment options. Our multidisciplinary Heart Failure Program offers outstanding experience and expertise with interventions such as heart transplant and ventricular assist devices to ease the burden of patients with failing hearts.

Selecting the right therapeutic approach for you or a loved one depends on a variety of factors, such as your specific diagnosis, overall health, preferences, and goals. The UT Southwestern Heart Failure team works closely with patients and families to help them make the most appropriate treatment choices.

About Our Program

The UT Southwestern Heart Failure Program provides patients with direct access to the very latest medications, devices, and procedures. We have eight physicians who are certified in the new American Board of Internal Medicine subspecialty of Advanced Heart Failure and Transplant Cardiology. This degree of specialization allows us to treat patients with even the most challenging of conditions.

UT Southwestern’s Heart Transplant Program has performed more than 600 heart transplants and has excellent outcomes. At 92.4 and 88.1 percent respectively, our one- and three-year survival rates surpass national averages for heart transplantation.

Our comprehensive transplant resources also enhance the care of patients who require heart-lung or heart-kidney transplantation. In fact, multi-organ transplants make up more than 10 percent of the heart transplants performed at UT Southwestern.

A growing number of heart failure patients now receive mechanical circulatory assist devices – pumps that help weakened hearts circulate blood throughout the body. Most of these devices are attached to the left ventricle of the heart, and are known as LVADs (left ventricular assist devices). Though LVADs were originally developed to assist patients awaiting heart transplant, they are increasingly being used as a permanent therapy (commonly called “destination therapy”).

UT Southwestern is part of an exclusive group of hospitals that has been authorized to implement and expand the use of LVAD as destination therapy.

What Every Patient Should Know About Heart Failure and Advanced Heart Failure

In patients with heart failure, the heart muscle has been damaged by underlying heart disease or other conditions, such as diabetes and high blood pressure. It may become too weak to pump blood efficiently, or too rigid to expand and allow adequate blood to fill its chambers. Fluid builds up in the lungs and other body tissues. Over time, the kidney and other organs will begin to break down.

There are four stages of heart failure. In stage A, people are at risk for developing heart failure due to high blood pressure, diabetes, or coronary artery disease. Stage B includes people who have structural heart disease that raises their risk for heart failure, but have not experienced symptoms. Stage C refers to patients with diagnosed, symptomatic heart failure. People with Stage D heart failure have advanced heart failure and experience ongoing symptoms of heart failure despite receiving medications. They require consideration for specialized therapeutic interventions.

Risk Factors for Heart Failure

Conditions such as coronary artery disease, high blood pressure, diabetes, cardiomyopathy, and certain arrhythmias (heart rhythm disorders) increase the likelihood of developing heart failure. Other risk factors include:

  • Increasing age
  • African-American descent
  • Chronic alcohol and/or drug abuse
  • Diabetes
  • Hyperthyroidism or hypothyroidism
  • Previous treatment with chemotherapy and/or radiation therapy for cancer
  • Obesity
  • Pulmonary hypertension
  • Sedentary lifestyle
  • Previous valvular heart disease
  • Previous coronary artery bypass surgery
  • Family history of heart failure

Symptoms

Some heart failure symptoms are caused by fluid backing up in the lungs, abdomen, or extremities. Others reflect the heart’s reduced ability to deliver oxygen-rich blood to the body. Symptoms that persist or worsen despite treatment indicate that heart failure is becoming more advanced.

Symptoms can include:

  • Abnormal heart rhythm or palpitations
  • Chronic cough or wheezing
  • Decreased urine production
  • Difficulty sleeping
  • Fatigue or fainting spells
  • Feeling of fullness, loss of appetite, or abdominal pain
  • Fluid retention; swollen extremities or abdomen (edema)
  • Loss of muscle mass
  • Nausea or vomiting
  • Rapid or prominent heartbeat (palpitations)
  • Shortness of breath upon exertion or when lying down
  • Sleep apnea
  • Weight gain

If you have a diagnosis of heart failure and have been hospitalized at least two times in the last year, you should ask your doctor to refer you to an advanced heart failure center for an evaluation.

Diagnosis

UT Southwestern cardiologists are often able to make a preliminary diagnosis of heart failure with a detailed medical history and careful physical examination. Blood and urine tests can reveal problems with the liver and kidneys, measure lipids and thyroid function, and detect signs of diabetes. In addition, one or more of the following diagnostic procedures may be performed:

  • Electrocardiogram (ECG or EKG) – indicates underlying heart problems such as heart enlargement, abnormal cardiac rhythms, and coronary artery disease
  • Echocardiography – a noninvasive test that uses ultrasound to evaluate valve function, pumping capacity, and structural heart changes
  • Cardiac MRI – evaluates the structure and function of the heart and looks for scars
  • Cardiopulmonary stress test – measures your level of fitness, or aerobic capacity
  • Cardiac catheterization/angiography – looks for blockages in the coronary arteries

Treatment

Medical regimens often include combinations of drugs to address particular conditions and symptoms while minimizing side effects. These drugs may include angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), angiotensin-receptor antagonists combined with a neprilysin inhibitor (ARNi), beta blockers, vasodilators, diuretics, or digitalis.

Surgical procedures to help ease heart failure include implantation of a pacemaker or cardioverter defibrillator to prevent arrhythmias, as well as bypass surgery or angioplasty when there are blocked coronary arteries.

Patients with advanced heart failure who have not been helped by the above treatments may be candidates for heart transplants or ventricular assist devices.

Heart Transplant

The UT Southwestern Heart Transplant Program provides patients with full access to UT Southwestern’s multidisciplinary medical resources and highly personalized care. Cardiothoracic surgeons, advanced heart failure cardiologists, anesthesiologists, nurses, transplant coordinators, social workers, rehabilitation therapists, nutritionists, and pharmacists work together to deliver comprehensive treatment.

Our transplant team provides patients with extended medical management, care, and support following transplant. Post-transplant patients complete a program of supervised cardiac rehabilitation. They also receive education on their new medical regimens and assistance with the adjustments post-transplant life requires. Most patients are able to return to a normal lifestyle, including recreational activities, within three to six months.

Ventricular Assist Devices

Ventricular assist devices are small, battery-operated devices that help the heart pump blood. Depending on individual patient needs, VADs can be appropriate for short-, intermediate-, and long-term use.

The most commonly used type, known as an LVAD (left ventricular assist device), is a mechanical pump that serves as a partial artificial heart. Implanted during an open procedure, an LVAD helps the left ventricle pump oxygen-rich blood to the aorta and the body. The devices are steadily getting smaller, more durable, more reliable, and easier to implant, bringing the potential for a longer, healthier life to an ever-expanding group of patients. LVADs can help heart failure patients who:

  • Are considered too elderly for heart transplant
  • Have a body-mass index considered too high for heart transplant
  • Have myocarditis
  • Have undergone heart surgery but cannot be safely removed from cardiopulmonary bypass
  • Have another contraindication to heart transplant
  • Are on the heart transplant list but are not stable enough to wait for a donor heart to become available

UT Southwestern’s LVAD team participates in many high-profile studies of LVADs, including multicenter trials sponsored by the National Institutes of Health and ongoing research to investigate indications that prolonged LVAD use may actually help damaged hearts to heal.

Support and Ongoing Care

UT Southwestern offers a wide range of resources to help heart failure patients adopt helpful lifestyle modifications and comply with medical regimens. Our Heart and Lung Transplant Clinic cares for patients with advanced heart failure, ventricular assist devices, and pulmonary hypertension in a hospital-based outpatient setting.

Services include patient education, stress management, closely supervised cardiovascular rehabilitation, support resources, and long-term follow-up. All are designed to help patients stay out of the hospital, improve their well-being, and extend their lives.

Make an Appointment

To schedule an appointment or learn more about what UT Southwestern offers to patients with advanced heart failure, request an appointment online or call 214-645-5505. Referring physicians may call our 24-hour intake line at 1-877-391-1528.

Advanced Heart Failure Physicians

Heart Transplant and LVAD Surgeons

Locations

Heart and Lung Clinic
Professional Office Building 2
5959 Harry Hines Blvd.
6th Floor, Suite 600
Dallas, Texas 75390-9253

Cardiology Clinic
Medical Center at Park Cities
8611 Hillcrest Road
Suite 300
Dallas, Texas 75225

Cardiology Clinic
Medical Center at Richardson/Plano
3030 Waterview Parkway
Richardson, Texas 75080