Maggie McKay (Host): Welcome to Conversations Like No Other: Heart Care, presented by the Heart and Vascular Institute of Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad, everyday cardiac topics to discuss very real and very specific subjects that impact your heart health. We think you'll enjoy our fresh take.

Thanks for listening. I'm your host, Maggie McKay. Today, we have with us Dr. Samit Shah, Director of the Mechanical Circulatory Support Program at the Valley Hospital, to give us an in-depth look at heart failure care, from diagnosis to advanced management, and how coordinated team-based approaches improve outcomes. Thank you so much for being here.

Dr. Samit Shah: Thank you so much for having me, Maggie.

Host: So to begin, what exactly is heart failure and what are some of the most common causes that lead to this condition?

Dr. Samit Shah: You know, heart failure invokes a lot of anxiety, I'll just say first off, in that many people when told they have "heart failure," they worry that their heart has stopped working. I want to just highlight that we, as a program, have pivoted to something more positive in terms of our terminology. So, we talk about ourselves being heart failure recovery program to help people achieve the best possible outcomes in their quality of life possible. But heart failure doesn't mean that the heart has stopped working. It just simply means that it's not pumping efficiently to meet the body's needs, or that it can't relax well enough to fill properly between beats.

And this is actually, unfortunately, a very common condition. Nearly seven million Americans are living with heart failure, and it's becoming one of the leading causes of hospitalization in adults over the age of 65. And that's primarily because many of us are living longer, surviving prior heart attacks in the past and, of course, that leads to injury to the heart, and then the heart pump function can be impaired.

So, the most common causes are coronary disease, longstanding high blood pressure, abnormalities of the heart valves, and some unfortunate individuals might have a hereditary condition. And so, it can be very much related to genetics. And then, we also see viral infections chemotherapy medications, and more common conditions like diabetes and obesity contribute to this.

But the important thing that I like to highlight is that we will help to identify the cause and find out ways that we can help treat the condition and help people obtain their best possible life.

Host: And you mentioned that when people hear heart failure, they assume it means the heart has stopped working, and that's not necessarily so. But can you explain what heart failure really means and how it can affect a person's daily life?

Dr. Samit Shah: Absolutely. And that can vary from one person to another. What someone might experience when they're told that they have heart failure is that they may find it more difficult to do things that they were easily able to do before, so walking up the stairs, gardening, carrying groceries. They may experience fatigue, some shortness of breath.

Commonly, they may experience swelling in the legs or the abdomen, and perhaps even difficulty lying flat because of fluid or congestion in the lungs. Another common symptom is shortness of breath when bending over to tie their shoes or pick up something from the ground. But again, as I mentioned, with today's therapies, many of these symptoms are manageable and can be resolved.

Host: So, you mentioned some symptoms. What other ones should people be aware of that might indicate heart failure, and when should somebody seek medical evaluation?

Dr. Samit Shah: So as mentioned, shortness of breath when laying down, needing more pillows to breathe better in the middle of the night. Sometimes people might find themselves sitting at the edge of the bed to breathe. Oftentimes they may see weight gain from fluid retention, a cough, really a reduction in their exercise tolerance as well. And if anyone sees these symptoms as being new or worsening or interfering with their daily life, I think those are indications where they should seek immediate attention.

Host: Treatment for heart failure has evolved significantly. What are some of the latest therapies or approaches that are improving outcomes for patients?

Dr. Samit Shah: Over the last several decades, we've made tremendous progress in taking care of patients that are dealing with heart failure. We have what we call the four pillars of medications. So oftentimes, patients with a very weak heart function may find themselves on something called beta blockers, such as metoprolol or carvedilol. They may be on Entresto, which is a medication that can help relax the blood vessels and help the heart pump more efficiently. Spironolactone and something called SGLT2 inhibitors. Those are like Farxiga, Jardiance. These are all medications that have previously been used for diabetes, but we've found that they're actually helpful in patients with heart failure, irrespective of whether they have diabetes or not. And we have certain monitors that we can use to help patients identify that they're retaining water before they become symptomatic and require hospitalization, something called a CardioMEMS.

And I'll just highlight two additional therapies called a cardiac therapy, which is a device that can help the heart pump more efficiently, as well as Barostim. As the Director of Mechanical Circulatory Support at Valley, we have actually brought forth a very revolutionary device that has helped many, many people with very weak hearts where the ejection fraction, which is the pump function of the heart, to be maybe 20%, normal being 55-60%. And that device is called the LVAD, called the left ventricular assist device. And this can actually help someone's quality of life and their survival improve from, say, a couple months or a year to equivalent to that of transplant to about eight to 10 years. And it can help them return to a very functional life and be with their families.

Host: Heart failure care often involves a multidisciplinary team. Can you describe the different specialists involved and how this coordinated approach benefits patients?

Dr. Samit Shah: What we know is that heart failure, the management of heart failure really is a team sport. We work with patients' primary care doctors, their electrophysiologists. We have social workers. We have pharmacists. We have surgeons that are involved in taking care of patients when they need some kind of operation to help their heart pump better. And it really requires an approach to figure out the best strategy to help a patient.

Host: And for patients with more advanced heart failure, what treatment options are available beyond medications?

Dr. Samit Shah: So, there are devices, such as the cardiac resynchronization therapy or implantable defibrillators, that are designed to help patients survive arrhythmias that are very dangerous. And there are also devices called the Barostim or cardiac contractility modulation. These are devices that are through various means able to help the heart pump more efficiently beyond just pharmacologic or beyond medications. And as I mentioned, left ventricular assist devices and, in some cases, heart transplantation, which can help someone's survival remarkably be prolonged.

Host: And what message would you like listeners to take away about heart failure, especially regarding early intervention and the importance of ongoing care?

Dr. Samit Shah: I think the most important message is that heart failure is treatable, that we'll strive to help recover much of their functionality and their life as much as possible, and early diagnosis truly matters. So when someone starts getting short of breath, they may start dismissing that as just getting older, but it's truly potentially highlighting something that is happening that we need to address.

And I would encourage patients to be active partners in their care, so of course, taking their medications, communicating with their physicians, monitoring their weights and symptoms. What I often ask my patients to do is really ask themselves, "Am I able to do less than I was able to do a year ago? Do I find my medications not being tolerated much nowadays? Is my blood pressure too low? Have doctors told me that I'm having kidney or liver issues?" These might be indicative that the heart is not pumping as well as it once used to, and they may benefit from an evaluation for more advanced therapies that can be life-saving.

Host: Is there anything else in closing that you'd like to add that you think people need to know?

Dr. Samit Shah: Yeah, I think the important thing is that people should know that heart failure is treatable and that there is hope. There are options available when maybe sometimes they may hear from others that there aren't options, that we would certainly find options that will help them achieve their goals and improve their outcomes as much as possible.

Host: Thank you so much for sharing your expertise today. This has been very informative, and we appreciate your time.

Dr. Samit Shah: Thank you so much for having me.

Host: Of course. Again, that's Dr. Shah. I'm Maggie McKay. We hope today's conversation has given you a clearer understanding of heart failure. While heart failure is a serious condition, advances in care and a coordinated team approach are making a meaningful difference for patients every day. If you or a loved one has questions about heart failure or concerns about heart health, talk with your healthcare provider.

To learn more about heart failure care and cardiovascular services at Valley, visit valleyhealth.com/heart. And as always, be sure to subscribe, share this episode, and take good care.