Joey Wahler (Host): It's the leading cause of death globally. So, we're discussing heart failure. Our guest is Dr. Hassan Alhosaini. He's a cardiologist. This is Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome.

Hassan Alhosaini, MD: Thank you, Joey. I'm glad to be here.

Host: Pleasure. We appreciate the time. So first, simply put, what's meant by the term heart We've all heard it. What does it actually mean and what the most common causes of it?

Hassan Alhosaini, MD: So, heart failure does not mean that the heart has stopped. I often hear that from my patients. It means that the heart is no longer pumping blood as efficiently as the body needs. You know, think of it like a pump that's becoming weaker and weaker over time. You know, and because of that, the body may not be receiving enough oxygen and nutrients, and the fluid can build up in the lungs and legs.

Now, the most common causes are coronary artery disease and previous heart attacks, you know, long-standing high blood pressure, diabetes, and maybe, in some cases, inherited heart muscle conditions and maybe rarely chemotherapy and other toxins that can affect the heart.

Host: And I'm glad you addressed that misconception that failure does not in fact mean your heart has stopped. Excellent. So that being said, how does heart failure impact a patient's daily life overall health?

Hassan Alhosaini, MD: So, thank you, Joey. That's a really good question because I hear this from my patients obviously day in, day out, that this condition can affect every aspect of their daily life. You know, many people notice that they're more tired than usual, doing usual daily activities. They can't walk, they can't climb stairs, garden, you know, play with grandkids without having difficulty breathing, reflecting that the heart is not delivering adequate blood flow. I would say the vast majority of patients would struggle with shortness of breath and difficulty doing regular tasks of daily living.

And I would also, Joey, add that beyond the physical symptoms of heart failure, this condition can really affect the mental and emotional well-being of patients, including their independence, autonomy, and overall quality of life.

Host: Let me ask that because we don't much about it, the mental side of this. What are we talking about, Doctor? Talking about maybe a loss confidence or in demeanor because of fact that these physical changes are taking place? How does mental side manifest itself?

Hassan Alhosaini, MD: Well, I mean, obviously, the anxiety that is associated with learning that your heart is weak, the coping with this, the impact on people's lives and livelihoods, you know, and also feeling that they're somehow a burden on their caregivers and so on and so forth. So really, anxiety, depression adjustment issues, and the stress frankly that comes from learning about this diagnosis. Now, the encouraging news is that with appropriate treatment, we can address not only the physical aspect of heart failure, but also the emotional and mental aspect of it as well.

Host: Certainly great to hear and understandable that those things would be factors as well. So, you mentioned some of the typical symptoms. What are the early warning signs that people should be aware of that mean they need to seek professional help? Where's the line? How do you know when it's time?

Hassan Alhosaini, MD: Well, this is a difficult one, because most of us attribute these symptoms of tiredness and a little bit of shortness of breath to, you know, being out of shape, deconditioned, or maybe aging. Maybe not you, Joey. But generally speaking, when we get older, you know, we feel like, "Oh, I must feel tired. I must feel, you know, short of my breath."

I think the take-home message here is don't ignore your body, don't ignore your symptoms. Better get checked out, err on the side of safety, because early access to care ensures better outcomes in my opinion.

Host: Absolutely. So as you well know, Doc, a heart failure diagnosis can sound scary to people. But can you share with us how treatment options have improved over the years to certainly try and help ease some of those fears, right?

Hassan Alhosaini, MD: Yeah. This actually one of the most exciting stories of modern medicine, what is going on in cardiology, what is going on in advanced heart failure.

You know, 20 years ago or so, our options were extremely limited. Today, we have numerous medications, a myriad of, you know, interventions, not only to improve patients' symptoms, but actually to aim for remission of heart failure and heart recovery.

And beyond medications, there are implantable devices, remote monitoring technology and specialized heart failure clinics, you know, and advanced therapies focused on patient care to provide, you know, precision medicine, individualized care. So, really, the diagnosis of heart failure is no longer the beginning of the end. But rather in the beginning of, you know, treatment journey that hopefully will implement all these options leading to better outcomes.

Host: Absolutely. And I'm going to ask you more about one of those devices in just a moment. But first, you talked, of course, a moment ago about prevention and everything that goes along with that. But how about available treatment options for patients that do have late-stage heart failure? Where are things at regarding those patients?

Hassan Alhosaini, MD: Yeah. Now, let me preface by saying that the vast majority of patients do well and improve with medications and careful follow-up. However, you know, for those patients whose heart failure, you know, continues to worsen despite optimal treatment and disease management, we have, you know, advanced therapies. And these include specialized intravenous medications, maybe temporary mechanical circulatory support devices during critical illness, of course, heart transplantation as a cure for heart failure and then, importantly, left ventricular assist devices, we refer to it as LVAD.

You know, now every patientis different. We carefully evaluate which options offers the greatest benefits, while also considering, you know, their overall health and personal goals. In other words, it's not just about the latest and greatest and the best technology, but we have to apply this to individual patients and be holistic in our approach, because it's not just about heart replacement therapy, it's also about the whole body.

Host: And speaking of which, I'm going to ask you about treating the whole body in just a moment. So, a little quick tease there. But first, let's wrap up on what I mentioned a moment ago, a left ventricular assist device or LVAD, as you point out, the acronym for that. What is that? How does it work? And is it in fact a better option than a heart transplant for some patients?

Hassan Alhosaini, MD: An LVAD is a mechanical pump that is surgically implanted to help the weakened left side of the heart circulate blood throughout the body. It doesn't really replace the heart, it works alongside it. So, it's a parallel circuit, if you will. And, you know, many patients experience dramatic improvement in their energy level, breathing, quality of life, all the symptoms that we've been talking about, following a LVAD surgery, obviously, once they get over the hump of recovery post the LVAD surgery.

Now, your question is whether LVAD is better than a transplant. They're really different treatments rather than competing treatments. You know, heart transplant replaces the diseased heart with a donor heart, while an LVAD support supports the patient's own heart. You know, some patients receive an LVAD while waiting for transplant, while others receive it, you know, as more like a destination long-term therapy, because transplantation is not the best option for them.

So really, the bottom line, the best treatment is the one that is right for that individual patient. So, that's part of precision medicine, individualized care, what the multidisciplinary team offers when we initiate the evaluation for advanced heart failure therapies.

Host: And you led me perfectly, Doc, right on cue into my next question about multidisciplinary care. You mentioned a moment or two ago that you try and treat the entire patient, not just their heart. Often these are patients that have various things going on. So, what does that mean in this particular case, multidisciplinary?

Hassan Alhosaini, MD: Yeah. And I think this is probably the most important part of this conversation to highlight the role of the whole team. Heart failure care is a team sport, it's a team effort. You know, for example, at Novant Health, patients aren't cared for when they have advanced heart failure by one physician alone. You know, they have access to a highly coordinated team that includes an advanced heart failure cardiologist, surgeon, highly specialized NPs and PAs, you know, heart failure pharmacists, nurses, social workers, you know, and importantly, palliative care experts, so that we can provide supportive care, holistic whole person care. You know, everyone works together with one shared goal, which is helping patients live longer, feel better, and avoid unnecessary hospitalizations.

So in a nutshell, you know, this coordinated approach is one of the reasons why outcomes continue to improve with advanced heart failure, not necessarily because we have the latest and greatest pump technology. I mean, that of course is important, but it's not sufficient alone, you know?

Host: And in summary here, Doctor, what most excites you about the future of heart failure care? We can hear the passion you have for what you do in your voice. I could see it in your eyes. What are you most looking forward to that's on the horizon?

Hassan Alhosaini, MD: Honestly, we're entering a very exciting era, where, you know, care for advanced heart failure patient and medical patients in general is becoming more proactive instead of reactive, you know? So instead of waiting until a patient becomes sick and enough to require hospitalization, we're increasingly more and more trying to detect early warning signs, you know? So, remote monitoring, wearable technology and, yes, AI and implantable sensors, all these improved technologies allow us to develop new strategies, new approaches to these patients upstream, you know? So, also, we continue to develop new medications, new devices to improve patients' outcomes.

You know, I can sum this up and say I truly believe that in the next, you know, decade or so, heart failure care will be transformed where we are increasing patient survival, adding years to patients' lives, but also adding life to these years, you know? So, I think that's important to keep in mind, you know?

Host: That's a great slogan in the making, right? Not just adding years to their life, but life to their ears. I smell a bumper sticker here. Do they still have bumper stickers, Doc?

Hassan Alhosaini, MD: Yeah.

Host: Then finally, I've got to ask you this. Even after all these years of modern medicine, as a cardiologist, does the heart remain as fascinating to you as it does to we lay folks?

Hassan Alhosaini, MD: Absolutely. Absolutely. And we're learning more and more about it. When I was in medical school, which was decades ago, you know, we did not think that the heart has the capacity to regenerate. And now, we have new science, new research to kind of show that actually it does regenerate, which offers great hope for patients with broken heart disease, where we can definitely look forward to regenerative medicine. So, that's exciting, and I look forward to that.

Host: Absolutely. Well, folks, we trust you're now more familiar with heart failure, how it can be prevented and addressed. Again, heart failure does not mean your heart has stopped. Doctor, keep up all your great work and your wonderful passion, and thanks so much again.

Hassan Alhosaini, MD: Thank you so much, Joey.

Host: Absolutely. And to find a physician, please visit novanthealth.org. For more health and wellness information from our experts, please visit healthyheadlines.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks again for being part of Meaningful Medicine, a Novant Health podcast.