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New Hope For Advanced Heart Failure · Meaningful Medicine with Novant Health

• 0:04
  Joey Wahler (Host): It's the leading cause of death globally.
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  So, we're discussing heart failure.
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  Our guest is Dr.
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  Hassan Alhosaini.
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  He's a cardiologist.
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  This is Meaningful Medicine, a Novant Health podcast, bringing you
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  access to leading doctors who answer questions they wish you would ask.
• 0:20
  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  Thanks so much for joining us.
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  I'm Joey Wahler.
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  Hi there, Doctor.
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  Welcome.
• 0:33
  Hassan Alhosaini, MD: Thank you, Joey.
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  I'm glad to be here.
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  Host: Pleasure.
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  We appreciate the time.
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  So first, simply put, what's meant by the term heart We've all heard it.
• 0:43
  What does it actually mean and what the most common causes of it?
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  Hassan Alhosaini, MD: So, heart failure does not mean that the heart has stopped.
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  I often hear that from my patients.
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  It means that the heart is no longer pumping blood as
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  efficiently as the body needs.
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  You know, think of it like a pump that's becoming weaker and weaker over time.
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  You know, and because of that, the body may not be receiving enough
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  oxygen and nutrients, and the fluid can build up in the lungs and legs.
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  Now, the most common causes are coronary artery disease and previous heart attacks,
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  you know, long-standing high blood pressure, diabetes, and maybe, in some
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  cases, inherited heart muscle conditions and maybe rarely chemotherapy and
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  other toxins that can affect the heart.
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  Host: And I'm glad you addressed that misconception that failure does not
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  in fact mean your heart has stopped.
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  Excellent.
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  So that being said, how does heart failure impact a patient's
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  daily life overall health?
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  Hassan Alhosaini, MD: So, thank you, Joey.
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  That's a really good question because I hear this from my patients obviously
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  day in, day out, that this condition can affect every aspect of their daily life.
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  You know, many people notice that they're more tired than usual,
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  doing usual daily activities.
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  They can't walk, they can't climb stairs, garden, you know, play with
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  grandkids without having difficulty breathing, reflecting that the heart
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  is not delivering adequate blood flow.
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  I would say the vast majority of patients would struggle with
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  shortness of breath and difficulty doing regular tasks of daily living.
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  And I would also, Joey, add that beyond the physical symptoms of heart failure,
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  this condition can really affect the mental and emotional well-being of
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  patients, including their independence, autonomy, and overall quality of life.
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  Host: Let me ask that because we don't much about it, the mental side of this.
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  What are we talking about, Doctor?
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  Talking about maybe a loss confidence or in demeanor because of fact that
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  these physical changes are taking place?
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  How does mental side manifest itself?
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  Hassan Alhosaini, MD: Well, I mean, obviously, the anxiety that is associated
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  with learning that your heart is weak, the coping with this, the impact on people's
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  lives and livelihoods, you know, and also feeling that they're somehow a burden on
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  their caregivers and so on and so forth.
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  So really, anxiety, depression adjustment issues, and the stress frankly that
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  comes from learning about this diagnosis.
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  Now, the encouraging news is that with appropriate treatment, we can
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  address not only the physical aspect of heart failure, but also the emotional
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  and mental aspect of it as well.
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  Host: Certainly great to hear and understandable that those
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  things would be factors as well.
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  So, you mentioned some of the typical symptoms.
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  What are the early warning signs that people should be aware of that mean
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  they need to seek professional help?
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  Where's the line?
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  How do you know when it's time?
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  Hassan Alhosaini, MD: Well, this is a difficult one, because most of us
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  attribute these symptoms of tiredness and a little bit of shortness of
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  breath to, you know, being out of shape, deconditioned, or maybe aging.
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  Maybe not you, Joey.
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  But generally speaking, when we get older, you know, we feel
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  like, "Oh, I must feel tired.
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  I must feel, you know, short of my breath."
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  I think the take-home message here is don't ignore your body,
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  don't ignore your symptoms.
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  Better get checked out, err on the side of safety, because early access to care
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  ensures better outcomes in my opinion.
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  Host: Absolutely.
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  So as you well know, Doc, a heart failure diagnosis can sound scary to people.
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  But can you share with us how treatment options have improved over
• 4:49
  the years to certainly try and help ease some of those fears, right?
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  Hassan Alhosaini, MD: Yeah.
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  This actually one of the most exciting stories of modern medicine, what
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  is going on in cardiology, what is going on in advanced heart failure.
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  You know, 20 years ago or so, our options were extremely limited.
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  Today, we have numerous medications, a myriad of, you know, interventions,
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  not only to improve patients' symptoms, but actually to aim for remission
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  of heart failure and heart recovery.
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  And beyond medications, there are implantable devices, remote monitoring
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  technology and specialized heart failure clinics, you know, and
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  advanced therapies focused on patient care to provide, you know, precision
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  medicine, individualized care.
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  So, really, the diagnosis of heart failure is no longer the beginning of the end.
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  But rather in the beginning of, you know, treatment journey that
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  hopefully will implement all these options leading to better outcomes.
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  Host: Absolutely.
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  And I'm going to ask you more about one of those devices in just a moment.
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  But first, you talked, of course, a moment ago about prevention and
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  everything that goes along with that.
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  But how about available treatment options for patients that do
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  have late-stage heart failure?
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  Where are things at regarding those patients?
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  Hassan Alhosaini, MD: Yeah.
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  Now, let me preface by saying that the
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  vast majority of patients do well and improve with
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  medications and careful follow-up.
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  However, you know, for those patients whose heart failure, you know,
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  continues to worsen despite optimal treatment and disease management, we
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  have, you know, advanced therapies.
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  And these include specialized intravenous medications, maybe
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  temporary mechanical circulatory support devices during critical illness, of
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  course, heart transplantation as a cure for heart failure and then,
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  importantly, left ventricular assist devices, we refer to it as LVAD.
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  You know, now every patientis different.
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  We carefully evaluate which options offers the greatest benefits, while
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  also considering, you know, their overall health and personal goals.
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  In other words, it's not just about the latest and greatest and the best
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  technology, but we have to apply this to individual patients and be holistic
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  in our approach, because it's not just about heart replacement therapy,
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  it's also about the whole body.
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  Host: And speaking of which, I'm going to ask you about treating
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  the whole body in just a moment.
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  So, a little quick tease there.
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  But first, let's wrap up on what I mentioned a moment ago, a left
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  ventricular assist device or LVAD, as you point out, the acronym for that.
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  What is that?
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  How does it work?
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  And is it in fact a better option than a heart transplant for some patients?
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  Hassan Alhosaini, MD: An LVAD is a mechanical pump that is
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  surgically implanted to help the weakened left side of the heart
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  circulate blood throughout the body.
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  It doesn't really replace the heart, it works alongside it.
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  So, it's a parallel circuit, if you will.
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  And, you know, many patients experience dramatic improvement in their energy
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  level, breathing, quality of life, all the symptoms that we've been talking
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  about, following a LVAD surgery, obviously, once they get over the hump
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  of recovery post the LVAD surgery.
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  Now, your question is whether LVAD is better than a transplant.
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  They're really different treatments rather than competing treatments.
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  You know, heart transplant replaces the diseased heart with a donor
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  heart, while an LVAD support supports the patient's own heart.
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  You know, some patients receive an LVAD while waiting for transplant,
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  while others receive it, you know, as more like a destination long-term
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  therapy, because transplantation is not the best option for them.
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  So really, the bottom line, the best treatment is the one that is
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  right for that individual patient.
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  So, that's part of precision medicine, individualized care, what
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  the multidisciplinary team offers when we initiate the evaluation for
• 9:00
  advanced heart failure therapies.
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  Host: And you led me perfectly, Doc, right on cue into my next question
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  about multidisciplinary care.
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  You mentioned a moment or two ago that you try and treat the entire
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  patient, not just their heart.
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  Often these are patients that have various things going on.
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  So, what does that mean in this particular case, multidisciplinary?
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  Hassan Alhosaini, MD: Yeah.
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  And I think this is probably the most important part of this conversation to
• 9:27
  highlight the role of the whole team.
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  Heart failure care is a team sport, it's a team effort.
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  You know, for example, at Novant Health, patients aren't cared
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  for when they have advanced heart failure by one physician alone.
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  You know, they have access to a highly coordinated team that includes an
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  advanced heart failure cardiologist, surgeon, highly specialized
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  NPs and PAs, you know, heart failure pharmacists, nurses, social workers, you
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  know, and importantly, palliative care experts, so that we can provide supportive
• 10:01
  care, holistic whole person care.
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  You know, everyone works together with one shared goal, which is helping
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  patients live longer, feel better, and avoid unnecessary hospitalizations.
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  So in a nutshell, you know, this coordinated approach is one of the
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  reasons why outcomes continue to improve with advanced heart failure,
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  not necessarily because we have the latest and greatest pump technology.
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  I mean, that of course is important, but it's not sufficient alone, you know?
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  Host: And in summary here, Doctor, what most excites you about the
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  future of heart failure care?
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  We can hear the passion you have for what you do in your voice.
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  I could see it in your eyes.
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  What are you most looking forward to that's on the horizon?
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  Hassan Alhosaini, MD: Honestly, we're entering a very exciting era, where,
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  you know, care for advanced heart failure patient and medical patients
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  in general is becoming more proactive instead of reactive, you know?
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  So instead of waiting until a patient becomes sick and enough to require
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  hospitalization, we're increasingly more and more trying to detect
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  early warning signs, you know?
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  So, remote monitoring, wearable technology and, yes, AI and implantable sensors, all
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  these improved technologies allow us to develop new strategies, new approaches
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  to these patients upstream, you know?
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  So, also, we continue to develop new medications, new devices
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  to improve patients' outcomes.
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  You know, I can sum this up and say I truly believe that in the next,
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  you know, decade or so, heart failure care will be transformed where we are
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  increasing patient survival, adding years to patients' lives, but also
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  adding life to these years, you know?
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  So, I think that's important to keep in mind, you know?
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  Host: That's a great slogan in the making, right?
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  Not just adding years to their life, but life to their ears.
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  I smell a bumper sticker here.
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  Do they still have bumper stickers, Doc?
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  Hassan Alhosaini, MD: Yeah.
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  Host: Then finally, I've got to ask you this.
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  Even after all these years of modern medicine, as a cardiologist, does
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  the heart remain as fascinating to you as it does to we lay folks?
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  Hassan Alhosaini, MD: Absolutely.
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  Absolutely.
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  And we're learning more and more about it.
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  When I was in medical school, which was decades ago, you know,
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  we did not think that the heart has the capacity to regenerate.
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  And now, we have new science, new research to kind of show that actually
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  it does regenerate, which offers great hope for patients with broken heart
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  disease, where we can definitely look forward to regenerative medicine.
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  So, that's exciting, and I look forward to that.
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  Host: Absolutely.
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  Well, folks, we trust you're now more familiar with heart failure, how
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  it can be prevented and addressed.
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  Again, heart failure does not mean your heart has stopped.
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  Doctor, keep up all your great work and your wonderful passion,
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  and thanks so much again.
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  Hassan Alhosaini, MD: Thank you so much, Joey.
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  Host: Absolutely.
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  And to find a physician, please visit novanthealth.org.
• 13:13
  For more health and wellness information from our experts,
• 13:16
  please visit healthyheadlines.org.
• 13:19
  If you found this podcast helpful, please do share it on your social media.
• 13:22
  I'm Joey Wahler.
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  Thanks again for being part of Meaningful Medicine, a Novant Health podcast.