PL Wahi Oration 2017 / Management of Advanced Heart Failure

Prof Balram Airan
Dean, Chief Cardiothoracic Centre, HOD CTVS, All India Institute of Medical Sciences, New Delhi, India

Heart failure is a major health problem globally and become a highly lethal pandemic. Average prevalence of heart failure in most countries is 1.5 – 2 % and many of these patients progress to the stage advanced heart failure. It places major drain on healthcare systems in terms of resources consumed and also causes severe family disturbance to the persons afflicted with this entity. 

Guidelines from American Heart Association help to identify the patients with advanced heart failure. Left untreated, almost 50 % of the patients die within 1 year of diagnosis; this mortality rate is higher than many forms of cancer and HIV infection also. Various treatment options are available for such patients and all of them target to achieve control of patients’ symptoms and possibly reverse the anatomical and physiological alterations caused due to chronic advanced heart failure. These options include medicines like ACE inhibitors and Beta blockers which have significantly reduced mortality and newer drugs like ARNI (Angiotensin Receptor Neprilysin inhibitor).
Surgical options aim to either treat the causative factor for heart failure ( viz. CABG for coronary artery disease and myocardial infarction; Valve repair or replacement for mitral valve disease etc.) ; or  mechanical procedures on the dilated left ventricle to improve contractile efficiency of the failing left ventricle. Aggressive surgical options for patients in end stage heart failure include LVAD implantations and heart transplantation. LVADs, in spite of their high costs; are finding an increasing place in the destination therapy management of advanced heart failure patients. Donor availability is the only major hindrance that limits the use of the gold standard surgery for advanced heart failure – heart transplantation.

Newer research into stem cell biology, matrix protein structure and 3D printing enables taking the treatment field of AHF from clinics to laboratories. Many laboratories in the world are engaged in developing greater understanding to find the genetic / molecular triggers that set off the cascade of events leading to heart failure; or to synthesize healthy functioning human myocardium in a petri dish which can eventually be used to replace damaged muscles in human heart.
The field of heart failure research is immensely active in generating newer and reproducible breakthroughs in order to tackle the ever-growing burden of heart failure.