Transcription:

Andrew Wilner, MD (Host): Welcome to GW Doc Pod, a peer to peer podcast for medical professionals with The George Washington University Hospital. I'm your host, Dr. Andrew Wilner. I invite you to listen in, as we discuss advanced heart failure, treatments and techniques.

My guests today are Dr's Gurusher Panjrath and Supriya Batra. Dr. Panjrath is Associate Professor of Medicine at The George Washington University School of Medicine & Health Sciences and Director of the Heart Failure and Mechanical Circulatory Support Program at The George Washington University Hospital. Dr. Supriya Batra is Assistant Professor of Medicine at The George Washington University School of Medicine & Health Sciences and he is affiliated with The George Washington University Hospital as an advanced heart failure and transplant cardiologist.

Welcome, Doctors Panjrath and Batra.

Dr. Gurusher Panjrath: Pleasure to be here.

Dr. Supriya Batra: Hi, good to be here as well.

Andrew Wilner, MD (Host): Yeah, thanks for joining me. Dr. Panjrath, let's start with you. You are the Director of Heart Failure and Mechanical Circulatory Support Program at GW University Hospital. How common is heart failure?

Dr. Gurusher Panjrath: So heart failure is actually fairly common in the United States and across the world as you know well, Dr. Wilner. And it is in fact one of the most common diagnoses. When people are hospitalized the hospital in the United States, that is the most common diagnosis.

Andrew Wilner, MD (Host): Okay. So definitely merits having a program dedicated to that. So Dr. Batra, you know, I remember we have patients, you know, getting echoes all the time. In fact, I think every one of my patient gets an echo. And what is the purpose of echocardiography when it comes to a heart failure?

Dr. Supriya Batra: That's an excellent question. Both Dr. Panjrath and I specialize in heart failure. What I always personally like to echo to patients is that heart failure is a clinical diagnosis. It consists of fluid retention, volume retention, which can have signs and symptoms of swelling difficulty breathing on exertion or laying flat. In order for us to differentiate or further kind of delineate how to treat heart failure, an echocardiogram is key. That helps us decide where exactly in the heart the anatomical abnormality is. You can have left-sided heart failure. You can have right-sided heart failure. You can also have heart failure with normal cardiac structure, which may be a result of long-standing other comorbidities, such as hypertension. So it helps us delineate how to offer therapies and exactly what treatment options to give patients or offer patients depending on what their cardiac structure shows.

Andrew Wilner, MD (Host): Oh, that's great. That's very helpful. Dr. Panjrath, where does and when does mechanical support come in?

Dr. Gurusher Panjrath: That's a great question. So, you know, the heart failure is a spectrum and it's a journey and it can start early. And depending on people, different people may present differently. And we go through stages and this is where the American College of Cardiology and American Heart Association have over the years put out these stages of heart failure and pre-heart failure, depending on the risk factors which patients may have.

And as that stage evolves, if people start with structural changes, what Dr. Batra just alluded to, and then they start developing symptoms, in parallel to them are therapies and these are pharmacological therapies as well as preventive therapies, prevention like prevention for risk factors and then therapies such as what we call as heart failure medications or guideline-driven medical therapy, which is what has been proven to be efficacious or beneficial in these patients. And as they get instituted and patient, despite all good efforts, continue to progress with their condition either in the form of symptoms of fluid buildup, congestion or what we call as limited endurance or limited exercise capacity due to low blood flow flowing around, that's the stage where we start thinking about mechanical options in addition or in lieu of medical therapy. And this could be because patients may not respond to the traditional medication, which actually do work very well, or, you know, they have progressed so far out that the medications are not efficacious anymore.

Andrew Wilner, MD (Host): All right. So let's continue with this on mechanical support. You know, I'm a Star Trek fan and the captain has an artificial heart because he severely injured his last one and it got replaced. Do we do that or what do you mean by mechanical support?

Dr. Gurusher Panjrath: So again, there are different, you know, iterations of that. And the most traditional form when we say mechanical support, we refer to what is also known as a left ventricular assist device. This is a durable mechanical support, it means people or patients who need it get it, undergo surgery, get a device implanted in their heart, in the chest, and they actually can go home on it. And that's why we call it durable, because they're not dependent on staying in the hospital. The ones where you're required to stay in the hospital go into the bucket of temporary mechanical support devices. But you know, by large, we're talking about durable mechanical support, which is LVAD, the acronym for it. And what it does is it doesn't replace the heart, it assists the heart, and that's why we call it left ventriclar assist devices. These are devices which get implanted into the heart and on top of your native heart function, which is obviously struggling and that's why the patients need this assistance, these devices assist in further moving the blood along into the body and supplying it with different organs, including the brain.

Andrew Wilner, MD (Host): Okay. So you bring this thing home, I guess it needs a battery. Can you walk around with it? Or are you like stuck to the bed or is there a separate battery? How practical is it to have one of these things and how long, you know, can you have one?

Dr. Gurusher Panjrath: Absolutely. So the whole purpose of this is for people to go back to a certain degree of normalcy in their life and improvement in their quality of life and going back to things which they may have been doing with certain limitations or inherent limitations of technology. But the way it is treated inside of chest is connected with a cable on outside the body to a controller, which actually controls that pump which is within that mechanical support, which moves the blood around. And that controller is then connected to a portable batteries, which patients carry around whether, you know, in a backpack and around a halter. It could be, you know, just tied to the waist on a belt. So there are different ways they can carry it around. But they are not tethered to a cable to the wall, so they can freely move along. They can go, you know, drive. They can do activities of their normal living. They can go shopping and go out for dinners, restaurants, for walks. Most of the things are possible with that arrangement.

Andrew Wilner, MD (Host): Wow. So is it something you can have, in other words, is it a bridge to something like a heart transplant or is it something you could have more or less indefinitely?

Dr. Gurusher Panjrath: So they can be in both case scenarios. It can also be as a bridge to transplant for somebody who is a transplant candidate and use this as a first step and then can be either considered for heart transplant and is a candidate for it and then the transplant would replace that. Or if they are people who may not be candidates for transplant due to a bunch of reasons and, for those, this could be a permanent option where they would live on this pump for quite a long time.

Andrew Wilner, MD (Host): Dr. Batra, tell us what's new for heart failure patients.

Dr. Supriya Batra: I think that's a great question. We, in the year of 2022, are very excited in order to offer our spectrum of heart failure patients the most updated and guideline-directed medical therapies. These include very tailored therapies in an update of the heart failure guidelines that was actually just published on the 1st of April of this month, that differentiates our heart failure patients by echo, as I mentioned earlier in the podcast, to whether you have low heart function, meaning pump function, or high pump function. And we are now able to provide or offer oral therapies that are shown to make our patients feel better, stay out of the hospital longer, and honestly, hopefully improve their long-term trajectory.

Our hope is always for recovery and for clinical improvement with conservative management of these patients. If however that is not successful, we also in 2022, have a spectrum of other therapies to offer patients based on individual assessment in kind of case by case scenario. For example, we offer something called CardioMEMS, which is an implantable device that sits right outside of the heart in something called the pulmonary artery that is able to give us an assessment of how much fluid a patient is retaining and thus allowing us to tailor their therapy on an individual basis.

So in addition to CardioMEMS, consideration for advanced therapies, such as LVAD and heart transplantation, we also offer neuromodulation for patients with symptomatic heart failure. And again, all of these therapies can be considered on a patient-to-patient basis. But we do really provide a spectrum here, which again include oral therapies, which are medications by mouth. If unsuccessful, then consideration for implantable devices, which can monitor you clinically and other advanced therapies, which include, like I said, the Barostim device, LVAD and heart transplantation amongst others.

Andrew Wilner, MD (Host): Oh, well, that's great. It's great that patients have all of these options that are individualized. Well, doctors, Panjrath and Batra, we're just about out of time. Is there anything you'd like to add?

Dr. Gurusher Panjrath: What I would like to say is the most important thing for patients to remember is the term heart failure can be very threatening as well as depressing, and that's not the case. In 2022 and even beyond moving, the progress, which has been made over the last few years is tremendous. And there's a lot of hope, and that is the key thing. You know, finding the right the healthcare team, partnering with them, taking ownership of their care and finding the right therapy can improve things. And the overall quality of life, mortality and increased survival, which have come along with these therapies, is just tremendous. So the key thing is not lose hope because the diagnosis of heart failure, as bad as it sounds, does not necessarily need to be that and working with a healthcare team can change that.

Andrew Wilner, MD (Host): Well, thanks for those positive words of encouragement. Doctors Panjrath and Batra, thank you very much for this informative discussion about the modern approaches to heart failure treatment available at The George Washington University Hospital.

Dr. Supriya Batra: Thank you. It was a pleasure to be part of this.

Dr. Gurusher Panjrath: Thank you.

That concludes this episode of GW Doc Pod, a peer to peer podcast for medical professionals with The George Washington University Hospital. To refer your patient please call 1-888-4GW-DOCS. If you have a question for one of our specialists please email physicianrelations@gwu-hospital.com

Disclaimer: Physicians are independent practitioners who are not employees or agents of The George Washington University Hospital. The hospital shall not be liable for actions or treatments provided by physicians.

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