Heart Failure Program Expands to Include Recovery, Prevention

To many, heart failure means a person is at the end of life, struggling for breath. But that is not reality for most heart failure patients.

The Cardiovascular Division at the University of Miami Miller School of Medicine is addressing the needs of today’s heart failure patients by expanding the Heart Failure program to not only care for those with advanced heart failure but to also help patients with the disease live full lives, and to help those at risk for heart failure. Luanda Grazette, M.D., M.P.H., FACC, professor of medicine at the Miller School and director of Advanced Heart Failure, Heart Failure Recovery and Therapeutic Innovation at UHealth, joined UM in November 2020 to oversee the heart failure program’s expansion.

UHealth has a longstanding advanced intervention program for heart failure patients, including stem cell treatment and research, heart transplant at the Miami Transplant Institute at UM/Jackson Memorial Hospital, and ventricular assist device (VAD) placement (a device used to take over the pumping function for one or both heart ventricles in advanced heart failure), according to Dr. Grazette, formerly associate professor of clinical medicine and director of the Advanced Heart Failure and Cardiomyopathy program at the University of Southern California’s Keck School of Medicine.

However, only a small percentage of patients with heart failure will ever receive a heart transplant or VAD.

“About 6.2 million Americans have heart failure in the U.S., and that is projected to increase to more than 8 million by 2030,” Dr. Grazette said. “Most patients with heart failure need help with basically identifying those therapies, either pharmacologic or technological devices, that will optimize their cardiac function to improve their quality of life and survival.”

Heart failure treatment options have expanded in recent years. The challenge is finding the right intervention for the right patient, according to Dr. Grazette.

“At UHealth we use our strong diagnostic skill sets to target therapy according to an individual’s needs and risk. We focus not just on those interventions which improve quality of life and promote survival but also those which seem most likely to promote recovery,” Dr. Grazette said.

Recovery is becoming part of the dialogue and remission has become a recognized phenomenon in heart failure.

“There has always been a population of patients who seem to get better on therapy. I think for a long time no one knew what to do with those patients and possibly couldn’t believe their eyes. But in the last five years or so, we have started to examine this population in a dedicated way,” Dr. Grazette said. “Part of what we want to do here is take an intentional approach to promoting heart failure recovery and expanding the field by measuring those effects and changes that are associated with recovery, so that we can do a better job in the future of determining which patients have a chance of recovery and which patients should be considered early on for the life-saving interventions like transplant and VAD.”

Heart failure survival is improving, and heart failure has become increasingly similar to other chronic diseases, like diabetes.

“Patients need to know that. They should realize that by taking their medications, eating healthy, exercising, and following up with their clinicians, they can continue to have a good, meaningful life. This is not necessarily a death sentence,” Dr. Grazette said. “With current medical therapies, patients sometimes can return to a functional state similar to before they developed heart failure.”

As a result, the UHealth heart failure program will offer not only interventions and therapies for the various phases of heart failure, but also research studies, support groups and collaborations with other departments for a seamless patient experience.

“We are the first program in South Florida to offer the BaroStim Neo, which is the first neuromodulatory treatment for heart failure aimed at regulating cardiovascular function,” Dr. Grazette said. “We are going to be using a new type of pacemaker called the Optimizer Smart System, to improve heart function. And we are using sensor technology to remotely monitor patients with heart failure to improve care and prevent hospitalizations.”

Dr. Grazette is working with Miller School interventional cardiologists and electrophysiologists on devices that could improve the lives of patients with specific heart failure conditions. She also is working with a collaborator on blood tests that detect novel biomarkers that can help predict which patients are more likely to recover from heart failure.

The heart failure program is collaborating with multidisciplinary specialists, including the stem cell institute, electrophysiologists, interventional cardiologists, cardiac rehab, pulmonary hypertension, and sleep medicine experts to improve the quality of heart failure care.

“We also have a cardio-oncology focus. We do screening and surveillance for patients being treated for cancers who may be at high risk for cardiac dysfunction,” Dr. Grazette said. “And as part of the continuum of care and prevention of heart failure, we work closely with the Hypertension Center at the Miller School.”

The majority of heart failure patients started with hypertension decades before getting a diagnosis of heart failure, according to Maria Delgado-Lelievre, M.D., founder and director of the Hypertension Center and assistant professor of medicine at the Miller School.

“There is a strong relationship, both physiologically and mechanically, between longstanding hypertension and heart failure. Very early on in hypertensive patients you can see markers and signals that tell you this patient is developing initial phases of heart failure,” Dr. Delgado-Lelievre said. “One of the programs of the Hypertension Center is heart failure prevention, so you can personalize medicine targeting patients at risk of heart failure, coronary heart disease or arrythmia.”

The idea, according to Dr. Delgado-Lelievre, is to provide a continuum of care.

“Providing the spectrum of care with an array of established therapies and opportunities to receive some of the most promising new therapies that may not yet be available to the general public is our mission to meet the needs of today’s heart failure patients,” said Jeffrey Goldberger, M.D., chief of the Miller School’s Cardiovascular Division.