Heart Failure Treatment

Mount Sinai Heart recognizes that specialized and personalized health care is urgently needed to combat heart failure and reduce its prevalence — here and around the world. Our integrated approach bridges disciplines and offers patients at all stages of heart failure treatment and prevention plans, lifestyle management, the latest treatment technologies, and clinical studies.

"We offer the most aggressive, up-to-date treatment," says Jill Kalman, MD, Director of the Cardiomyopathy Program and Associate Professor of Cardiology. "Whether a patient needs medical therapy, implantable devices, research therapeutics, or surgery, we are a center that excels in treating heart failure, and that means better outcomes."

Treatment plans depend on the amount of damage to the heart, the underlying cause of heart failure, and the presence of other heart conditions. When medication and lifestyle modifications do not control symptoms or if the disease progresses, our experts will explore other options with patients and their physicians.

"With heart failure, you have to take care of the whole patient," Dr. Kalman says. "If patients come in with an illness like pneumonia or gall bladder trouble, these conditions can worsen their heart failure."

"We can delay the advancement of heart failure a decade or more through meticulous care and a partnership between patients and our multidisciplinary team," says Sean P. Pinney, MD, Director of the Advanced Heart Failure and Cardiac Transplant Program and Assistant Professor of Cardiology.

Our treatment plans include:

Comprehensive Medical and Lifestyle Management

Medical treatments for heart failure help the heart conserve and produce energy more effectively. A critical component of Mount Sinai Heart's individualized medical management program is educating patients and caregivers about medications, dietary issues, and beneficial lifestyle measures.

Elements of our Heart Failure Lifestyle Education Program include:

• Smoking cessation
• Weight management
• Exercise counseling
• Dietary counseling
• High blood pressure management

For many people living with heart failure, medications have been successful in treating their condition. Only a small number require more advanced treatment.

"Placing patients on the right combination of medications at the most effective dose as quickly as possible is key to the Mount Sinai approach," Dr. Kalman says. "We see patients every two weeks initially. That way, we know immediately if they aren't responding to the medications, and we can tailor their treatment sooner."

Once the right course of medication is set, our nurse practitioners and physician assistants, help keep it in place.

"Our nurse educators are an integral part of the team, counseling patients about medications and diet and helping them cope," Dr. Kalman says.

Cardiac Resynchronization Therapy

Mount Sinai Heart offers cardiac resynchronization therapy for patients who have moderate to severe heart failure and who have experienced electrical disturbances. This treatment approach uses a minimally invasive procedure to implant a specialized device called a biventricular pacemaker. It triggers the left and right ventricles to contract simultaneously and pump more blood.

The pacemaker, in combination with an implanted cardiac defibrillator, keeps the heart's rhythm at the right speed. Internal monitoring sensors transmit information remotely from the pacemaker to the heart failure team. The team can then make up-to-the-minute medication adjustments. Mount Sinai Heart uses a team approach to manage both devices.

"We have experts in echocardiography, device therapy, and medical management who confer with one another about the particular needs of each patient," says Avi Fischer, MD, Director of Pacemaker and Defibrillator Therapy and Assistant Professor of Cardiology.

Ventricular Assist Devices

Ventricular assist devices (VADs) are pumps that take over the function of damaged ventricles to boost circulation. Originally, these devices were developed as a "bridge to transplant" for hospitalized patients awaiting donor hearts. Today, these miniature, implantable devices are a first-line treatment and allow heart failure patients to live at home and resume many everyday activities.

The supply of donor hearts does not meet demand. The need for new technology to address heart failure drives Mount Sinai's increased use of assist devices.

"The growth of Mount Sinai's VAD program has been exponential," says Dr. Pinney. "As the technology continues to improve, the hope is to extend the lives of many more people who right now lack other options."

Candidates for ventricular assist devices include:

• Heart transplant candidates awaiting a donor
• People with severe heart failure who are not candidates for heart transplantation
• People recovering from acute heart failure who may require temporary support while they recover
• Patients who need emergency measures during open-heart surgery

Surgery for Heart Failure

Some heart failure patients' health may be complicated by other conditions such as valve disease or left ventricular aneurysm, which leaves a left ventricle misshapen and less efficient after a heart attack.

Surgical options include valve replacement or repair, as well as ventricular restoration surgery. One restoration technique known as the Dor procedure refashions the dilated left ventricle back to its original shape, enabling it to pump better. These types of surgery are associated with a higher level of risk than when performed on patients without heart failure.

Heart Transplantation

Mount Sinai Heart is one of only three heart transplant centers in New York City. Heart transplantation is a lifesaving option for patients facing end-stage heart failure. Our transplant team, which includes surgeons, cardiologists, social workers, dieticians, and various consultants, evaluates potential transplant patients.

"We ask referring cardiologists to assess their patients for transplant early on, before they are obvious candidates," says Dr. Pinney. "When they come to us, we want to see whether they haven't first exhausted all available medications, or might be candidates for device therapy or experimental therapies."

Once Mount Sinai Heart's transplant team sees the patient, the hospital's Recipient Review Committee will meet to determine suitability for transplant. If the Committee deems a patient a suitable candidate, he or she is placed on a waiting list managed by the United Network for Organ Sharing, an independent group that administers transplants nationwide.

Mount Sinai Heart offers an alternate listing program that matches patients with an expanded donor pool. This program extends transplantation options to older patients who are otherwise healthy and who previously may have been excluded from the standard organ matching process.