Approximately 6.2 million adults in the United States have heart failure. It is one of the most common chronic health conditions, and a leading cause of hospitalization among patients over 65 with mortality similar to some common cancers.1
Within the 4 stages of the American Heart Association / American College of Cardiology heart failure classification Stage C and Stage D (end-stage heart failure) are the most complex. Patients with Stage C or D heart failure have structural disease with progressive heart failure symptoms, and many require specialized treatments to help circulate and improve blood flow properly.2
One of the most significant challenges with progressive end-stage heart failure is the increased risk of multiple organ failure which may limit candidacy for advanced heart failure treatments. Isolated end-stage renal disease or end-stage liver disease may lead to combined liver or kidney transplant with heart transplantation in appropriate patients. Unfortunately, many with end-stage heart failure do not receive the timely treatment they need to reduce the risk of other organ failure and improve their chance of survival.
Effective Care Partnerships Enhance Treatment Options
Providing patients with access to suitable therapies at the right time is essential. The best way to achieve this is by early referral of Stage C and D patients to a heart failure program. Heart failure specialists in these programs can partner with primary cardiologists and other specialists to ensure optimal care and the appropriate treatment plan.
“Team collaboration is key for the care of all heart failure patients, particularly Stage C and beyond," says Eugene DePasquale, MD, medical director of the Heart Failure, Heart Transplantation and Mechanical Circulatory Support Program at Keck Medicine of USC. “It is important that primary cardiologists and internists partner with heart failure specialists to deliver the best possible and timely shared care for these patients. Patients can often use their window for consideration of advanced heart failure therapies. such as transplant and ventricular assist devices (VADs) if referred too late. Multiorgan transplant can be an option but in highly selected patients."
When a patient is working with specialists in a heart failure program, they get:
- Multidisciplinary care including pharmacy, nutrition and nursing.
- More timely transition to therapy
- Medications and procedural interventions essential to heart failure treatment
- Consideration for VAD or transplant before it is too late
For patients at an earlier stage of heart failure, heart failure specialists can partner closely with the cardiologist or internist coordinating their overall care. They may not need the same level of intensive treatment from specialists in the heart failure program, but specialists can monitor their overall health to ensure proper treatment at the appropriate time to reduce the risk of multiorgan failure.
Using VADs to Support Heart Function
VADs — mechanical pumps that support heart function and blood flow in people with weak or failing hearts-can improve patient quality of life and heart function. Unfortunately, these devices are often underutilized for endstage heart failure patients. When deployed at the proper stage of treatment, VADs can provide a bridge to get a patient safely to a transplant (bridge to transplant). If the patient is not a candidate for transplant, the VAD can improve quality of life for the time the patient has left (destination therapy).
Minimizing the Risk of Multiorgan Failure
The incidence of patients requiring dual-organ transplant — either heart-kidney transplant (HKT) or heart-liver transplant (HLT) — has steadily increased in recent years. It is an effective and appropriate treatment for someone with end-stage heart and kidney or liver failure.3
For multiorgan transplant to be successful, it requires the right expertise to identify eligible patients as soon as possible. Studies show that patients waiting for more than one organ transplant have higher mortality than single-organ cohorts.3
Specialists in a heart failure program can provide expertise on current guidelines for medical and ethical considerations for multiorgan transplant patients. They can also address practical considerations, including:
- Waitlist status for both organs
- Surgical approach to improve the chance of survival
- Donor selection to get the best match
- Ethical considerations of inequitable organ distribution when a single recipient receives two organs from separate donor waitlists
Partnering with a team of heart failure specialists, while providing shared care ensures timely referral and appropriate treatment for patients at the highest risk with end-stage heart failure.
1 Centers for Disease Control and Prevention. Heart Failure. Accessed 2/28/22.
2 Chen-Scarabelli C, Saravolatz L, Hirsh B, Agrawal.P, Scarabelli TM. Dilemmas in end-stage heart failure. J Geriatr Cardiol. 2015;12(1):57-65. doi:10.11909/j.issn.1671-5411.2015.01.007
3 Miklin DJ, Mendoza M, DePasquale EC. Two is better than one: when to consider multiorgan transplant. Curr Opin Organ Transplant. 2022;27(1):86-91. doi:10.1097/MOT.0000000000000951
4 Adigopula S, Vivo R, DePasquale EC et al. Management of ACCP/AHA Stage C Heart Failure.
Cardiology Clin. 2014; 32(1); 73-93. https://doi.org/10.1016/j.ccl.2013.09.012