Options for Heart Failure

Heart failure is a condition in which the heart is unable to pump blood to the rest of the body at a normal rate. There are approximately 550,000 new cases of heart failure each year resulting in about 300,000 deaths annually. An estimated 5 million Americans have heart failure.

At Barnes-Jewish Hospital, a major Midwest referral center for heart failure, Washington University physicians see more than 600 patients each year. Cardiothoracic surgeons are part of a multidisciplinary team that also includes cardiologists, skilled nurses and other dedicated caregivers. The team offers prevention and wellness programs, rehabilitation, diagnostic therapies, the latest medical treatments, leading-edge surgical treatments, heart transplantationventricular assist devices and access to clinical trials.

Many of the patients in the Heart Failure Program have such advanced disease that they are candidates for heart transplants. But the shortage of donor hearts means that only 8% of these patients will actually receive new hearts. Thus, the cardiology team must aggressively pursue other therapies, particularly the use of older drugs in more effective doses and the use of promising new agents available only in clinical trials.

Alternative Surgical Therapy 
Ventricular Assist Devices 
Options for Referring Physicians  

Alternative Surgical Therapy

Washington University heart surgeons offer a number of alternative surgical options for patients with heart failure. Although many of these procedures are high risk, these surgeons seek to identify those who have the most to gain, at the lowest possible risk, from surgical intervention.

Alternative surgical options include:

  • High-risk myocardial revascularization: revascularization of the heart muscle
  • High-risk left ventricular aneurysmectomy: repair of an aneurysm (ballooning) that occurs in the heart wall.
  • High-risk heart valve repair/replacement
  • Mitral valve repair in dilated cardiomyopathy: repair of the heart’s mitral valve in patients with dilated cardiomyopathy, a heart muscle disease that causes the heart to become enlarged

Ventricular Assist Devices

Washington University heart surgeons use ventricular assist devices as a temporary support system or as a “bridge to transplantation,” buying time in patients whose weakened hearts may deteriorate during the wait for a donor heart. The mechanical devices also are implanted as a permanent support system in some end-stage heart failure patients who are not candidates for a heart transplant.

Typically, an assist device is implanted in the patient’s abdomen and connected to the left ventricle of the heart to help pump blood.

When implanting ventricular assist devices, Washington University cardiac surgeons seek to minimize complications and to optimize results through measures such as early removal of tubes and heightened infection surveillance.

Options for Referring Physicians

Patient retrieval. Our physician-directed heart failure retrieval team can transport severely decompensated patients from another hospital to Barnes-Jewish Hospital in St. Louis. The team consists of a heart failure cardiologist, a heart failure clinical nurse specialist and a critical care nurse.

Single-session heart failure consultation. This single office visit assesses only the patient’s current heart failure status and long-term management options. Recommendations are forwarded to the primary care physician within 24 hours regarding:

  • Further suggested work-up
  • Possible modification of current medical regimen
  • Available drug or device trials
  • Candidacy for cardiac transplantation or other surgical intervention

Follow-up assessment visits can be requested. The referring primary care physician maintains complete control over the patient’s management.

Full-Time Heart Failure Management. An initial assessment is made at the first office visit, and changes in the heart failure medical regimen are instituted with full notification of the referring physician. Options for drug or device intervention are discussed with the patient and instituted with full notification of the referring physician.

Each patient is assigned a heart failure clinical nurse specialist whom the patient may call 24 hours a day with questions about his or her heart failure.

The referring physician is welcome to maintain day-to-day control over the patient’s management, but may opt to refer all management to the heart failure team.

Home Inotropic Infusion Clinic. Therapy for severe heart failure unresponsive to oral medication can include home intravenous inotropic infusion.

Close follow-up is carried out at a designated clinic specifically tailored to the needs of these patients. Since an informed patient is the foundation for successful home inotropic infusion, patient/family education is a primary focus of this clinic. Patients also have 24-hour access to heart failure clinical nurse specialists and physicians.

Our experience over the last 10 years with home inotropic infusion has been very successful. This therapy has allowed many pre-transplant patients to wait at home in a familiar environment, as well as offering extended quality of life to many end-stage heart failure patients who could not receive heart transplants.

More about the Heart Failure Program at Barnes-Jewish Hospital  

For a consultation regarding failure, call:

(888) 800-9484 (toll free)
(314) 362-7260