Advanced Therapies and Devices

If heart failure becomes harder to manage with lifestyle changes and medications alone, your care team may talk with you about more advanced therapies. They can help your heart work better and prevent dangerous heart rhythms. It may also be helpful to meet with an advanced heart failure team.

Why a Device Might Be Needed

Many people with heart failure are at risk for heart rhythm problems, or have a delay in the electrical signals to the bottom of the heart (known as a bundle branch block). Implanted devices can help address these problems.  

These devices can be useful to prevent sudden cardiac death or help the heart beat in a more coordinated manner in select patients.

• An implantable cardioverter defibrillator, or ICD, is a battery-powered device that keeps track of your heart rhythm. If it detects a dangerously fast heart rate, it sends a electric pulse or shock to reset the heart to a normal rhythm. This helps prevent sudden cardiac death. 

  Decision Aid: If an ICD is recommended, use this booklet for patients with heart failure to learn more about the device and understand your options. 

• With cardiac resynchronization therapy, or CRT, a small device is placed just below the collarbone. CRT sends electric signals to the lower chambers of the heart, helping them beat in a more coordinated way. This can help the heart to pump better, improve symptoms and quality of life and may prolong survival in properly selected patients.
  
  Some people receive a combination device called CRT-D, which includes both CRT and an ICD.

• A left ventricular assist device, or LVAD, is a battery-operated, mechanical pump. It is placed in the chest and helps the left ventricle (the main pumping chamber of the heart) pump oxygen-rich blood to the rest of the body.

  An LVAD may be an option for people with later stages of heart failure. For example, when:

  • Someone is awaiting a heart transplant. This is sometimes called a “bridge to transplant.”
  • A heart transplant isn’t an option. An LVAD serves as a longer term treatment to prolong their life. This is sometimes called “destination therapy.”

  Many patients say that an LVAD has helped them:

  • Get back to daily routines and activities that they enjoy
  • Breathe more easily
  • Sleep better
  • Live longer

  Because LVAD placement requires open-heart surgery, it’s not without risks. It also requires ongoing care.

  Decision Aid: If an LVAD is recommended, use this decision aid booklet to learn more about it and if it's right for you. 

Heart transplant is needed for some people with end-stage heart failure. It replaces the failing heart with one from a donor.

Talking With Your Care Team

Advanced therapies are not one-size-fits-all. Your care team can give you information on and provide advice on:

• Whether you might benefit from a device
• Which option is right for your situation
• What the procedure and recovery might involve
• How it may affect day-to-day life and if there are any restrictions on what you can do

Be sure to ask questions and share your goals.

Your heart team may also recommend palliative care support. This is an extra layer of support. Palliative care is different from hospice (end-of-life) care. It focuses on relieving symptoms, reducing stress and improving quality of life for patients and caregivers. It also helps make sure your care and any treatment decisions that are made align with your personal wishes and goals.