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Heart Failure Treatment Options

Modern Therapies

Common prescription drugs for the treatment of heart failure include:

Digoxin – this medicine is also useful for patients with a significantly weakened left ventricle. This drug may reduce risk of hospitalization and improve quality of life. Drug blood levels are monitored, to insure proper dosing.

Aldosterone Antagonists – These medications are considered an additional therapy for patients who continue to have symptoms of heart failure after they are already on diuretics, ACE inhibitors and beta-blockers. They block some of the negative effects of aldosterone on the heart muscle

Anticoagulants – this drug class should be prescribed for individuals with a history of atrial fibrillation or blood clots. Blood clotting times are monitored to insure proper dosing.

Angiotensin Receptor Blockers (ARB's) – These medications are sometimes used as an alternative when a patient is unable to take an ACE inhibitor due to side effects. Recent studies have shown that their benefit was not inferior to that of ACE inhibitors.

Angiotensin Converting Enzyme (ACE) inhibitors – this drug class should be taken by all patients who can tolerate them and who have a weakened left ventricle. ACE inhibitors have shown to prolong life, reduce the risk of hospital admission, and increase quality of life.

Beta-blockers – this drug class has also recently demonstrated to prolong life, reduce the risk of hospital admission, and increase quality of life. It is recommended that this drug be taken by all patients with a weakened left ventricle. A physician who has expertise in the treatment of heart failure should administer beta-blockers.

Diuretics – this drug class assists the body in excreting excess sodium and water. Sodium restriction in the diet is also recommended. Unfortunately, many diuretics also cause the body to excrete potassium; therefore, potassium blood levels are monitored and supplemental potassium prescribed, if necessary.

Hydralazine and Isosorbide – These medications are considered an additional therapy for patients who continue to have heart failure symptoms after they are already on diuretics, ACE inhibitors and beta-blockers. They have been found to be particularly effective in Africans Americans with hypertension.

What are implantable devices?
An implantable device is a small piece of equipment, much like a tiny computer, that keeps your heart beating normally. The size of the device varies, depending on what it does. Some are about the size of a wristwatch. The largest is smaller than a deck of cards.

Implantable pacemakers have been used to treat slow heart rhythms for 40 years. Today’s implantable devices treat other heart problems, such as heart failure. Implantable devices are placed under the skin, usually in the left chest wall and connected to the heart with tiny wires, called leads.

There are two basic types of implantable devices:

• Cardiac resynchronization therapy (CRT) pacemakers help the heart beat at a regular rhythm. CRT pacemakers can help improve heart failure symptoms by helping the chambers of the heart beat together. Your EKG and echocardiogram will tell us if you would benefit from this type of device.
• Implantable cardioverter defibrillators (ICDs) can give your heart a lifesaving shock to prevent cardiac arrest when you experience a dangerously fast rhythm. People with heart failure have a much higher risk of sudden death from life threatening heart rhythems. Many devices combine the above features in one device.

How do I know if I need a device?
If your ejection fraction (EF) is less than 35 percent and you have been on medical therapy for your heart failure for three to six months, your health care provider may recommend device therapy. You will then be referred to another physician, an electrophysiologist, who will make the final decision about device therapy. If you have any questions about devices, please ask your health care provider.

Electrophysiology

The University Hospital has one of the most advanced electrophysiology labs in the world. The electrophysiology, or EP, lab is used to correct abnormal heart rhythms, also known as arrhythmias or heart rhythm disorders. The irregular heartbeat may cause dizziness or fainting. They are normally harmless, but can cause cardiac arrest or even death.

An electrophysiology study (EPS) is a recording of the electrical activity within your heart. It is used to help your doctor determine the cause and treatment of a heart arrhythmia. During the test, an electrophysiologist inserts a catheter tube into your heart through your veins to test your heart’s electrical system and susceptibility to arrhythmias. The electrophysiologist may also safely reproduce an arrhythmia, and then give you medications to see which one controls it best.

Treatment Center Program

The treatment of heart failure is a collaborative approach. The Heart Failure Treatment Center brings together the very best expertise from The University Hospital, the Health Alliance and the University of Cincinnati (UC) College of Medicine

Using tools developed at The University Hospital and UC College of Medicine, the Heart Failure Treatment Center works in partnership with hospitals and physician practices around the Tristate. Experts at the Heart Failure Treatment Center assists community partners with patient care and access to cutting edge therapies, teaches clinicians in the field about the latest treatment options for heart failure patients and acts as a community resource for Greater Cincinnati.

Our team is made up of expertly trained clinicians from a number of disciplines specializing in the treatment of heart failure:

Physicians	Psychologists
Advanced Practice Nurses	Pharmacists
Nurse Coordinators/Case Managers	Exercise physiologist
Dietitians