The heart's primary function is to deliver enough blood through the arterial circulation to meet the body's metabolic demands under a variety of conditions ranging from a resting state, such as when one is asleep or sitting, to an active state when one is involved in heavy exercise. Blood flow delivers oxygen and nutrients through the arteries to maintain the function of all of the organs in our body, such as the brain, allowing us to think and control body function, to the heart so that it can act as an effective pump, to the kidneys and liver where toxins can be removed, and essential proteins necessary for body function are made and put into the circulation. The oxygen and nutrient-depleted blood, which has a purple-like color, is then returned to the heart through our system of veins, where the cycle of blood cells becoming oxygenated in the lungs leaves them a red color. The function of the heart must be flexible to meet the optimal metabolic needs of the organs and cells in the body under restful conditions as well as under stress, such as with exercise.

Heart failure occurs when the heart cannot adequately pump the blood it receives from the veins. Then it starts backing up in the lungs, leaving a person short of breath or backing up in the abdomen, causing a fluid collection called ascites or in one's legs and ankles called edema. This is why the most common symptoms of heart failure are shortness of breath under the demand of activity or if the heart failure condition is severe, short of breath while even sitting or lying down, edema or swelling of the ankles and legs, and a loss of exercise tolerance of fatigue. Severe heart failure can also lead to cognitive dysfunction, kidney disease, and liver failure.

There are two main types of heart failure. One is called heart failure with reduced ejection fraction (HFrEF), when the heart muscle is weakened, and heart failure with preserved ejection fraction (HFpEF) is, when the heart muscle loses its elasticity and becomes stiffened, limiting the amount of blood it can pump. The diagnosis of heart failure is not so difficult to make, and we need to identify these patients, even those with mild symptoms, because even they are predisposed to sudden death. Patients who have symptoms of shortness of breath with any activity or find themselves becoming easily fatigued with activities they would not have in the past, or if they have swelling of the ankles and feet need two tests; a blood test to check if the level of the heart stress hormone called brain natriuretic hormone (BNP) is elevated and then an ultrasound of the heart, otherwise known as an echocardiogram, to determine if the heart is weak (HFrEF) or stiff (HFpEF). It is important to distinguish between HFrEF and HFpREF as they have different treatments though both have a worse prognosis than many cancers.

There are many causes of weak heart syndrome, such as previous heart attacks, heart valve dysfunction, viruses, and alcohol abuse. Conditions such as high blood pressure and diabetes can contribute as well. Stiff heart syndrome (HFpEF) is associated with a thicker appearing heart muscle. This thickness can either occur from chronic conditions such as high blood pressure, diabetes, or aging or abnormal muscle cells in certain conditions such as hypertrophic cardiomyopathy or amyloid heart disease, where specific abnormal proteins and abnormal cells accumulate in the heart muscle.

Though the weak heart (HFrEF) and stiff heart (HFpEF) are entirely different, the symptoms, including shortness of breath, edema, and fatigue, are similar. They are both potentially lethal as patients die from abnormalities of heart rhythm called ventricular arrhythmias leading to sudden cardiac death, which is sudden and unexpected, or they can die from progressive worsening of the heart failure. Because the weak heart and stiff heart are two different diseases, they do not respond to all the same treatments. The main recommended HErEF treatments include beta-blockers, SGLT2 inhibitors, renin-angiotensin-aldosterone inhibitors, or soluble guanylate cyclase activators. Treatments for HEpREF also include the SGLT2 inhibitors and, to a lesser extent, renin-angiotensin-aldosterone inhibitors and do not generally use beta blockers. These treatments do a pretty good job of preventing complications of heart failure, including cardiovascular death, need for hospitalization, and quality of life, but only prevent 25-30% of these events.

The National Heart Institute focuses on 70-75% of patients predisposed to bad outcomes or has not tolerated or responded well to currently available treatments. We are investing resources in studying new treatments for this potentially life-threatening disease to extend the life of heart failure patients and enhance their quality of life.

So now, it is time to think a bit outside the box. Over the last five years, the focus of new drug development for heart failure has shifted to treating other conditions contributing to the horrible outcomes of heart failure, such as obesity, inflammation, and chronic kidney disease. We now realize that the fat cell is metabolically active and produces inflammatory compounds likely contributing to worsening outcomes in patients with heart failure.

We are evaluating a new generation of obesity treatments for obese patients with heart failure and targeting inflammatory proteins directed at the heart. We will also assess medical treatment for conditions such as amyloid deposits of proteins that poison the heart and hypertrophic cardiomyopathy. This often-inherited cardiac disorder is one of the leading killers of young athletes and disability in middle-aged patients. We are currently seeking patients with even mild symptoms of heart failure, such as shortness of breath with activity, a decrease in exercise tolerance, or swelling of the ankles and legs, who are obese or have excess inflammation, as one can determine by a simple blood test, hsCRP.

If you have been diagnosed with heart failure or feel like you have the symptoms described above, feel free to reach out to the National Heart Institute, a center of excellence for clinical trials, for us to answer any questions you may have and provide you with information on our currently enrolling clinical trials. There is no time to waste as the clock ticks on your heart failure condition, knowing it may have the same poor prognosis as many bad cancers. With so many potential good options in clinical trials, we hope to provide better outcomes for heart failure patients in the future.

We will work with you and your healthcare team to select the trial that works for you. There is no cost for participating in a clinical trial; if selected, most trials provide payments for each study site visit.

We’re here to help!

To learn more, visit our website @ nationalheartinstitute.org
or contact us at: info@nationalheartinstutute.org

Heart Failure: What It Is, What To Look For, And How NHI Can Help!