How Doctors Should Treat Congestive Heart Failure Today

The term “congestive heart failure” is falling out of favor with doctors. A Keck Medicine of USC cardiologist explains why — and why the shift may signal better outcomes for patients.

You’ve probably heard or read about congestive heart failure. Maybe you’ve even been told you have it, or know someone who has.

In the future, however, you may not encounter the “congestive” part of the diagnosis as frequently in discussions with your doctor or in health articles like this.

Why? As cardiologist Ajay S. Vaidya, MD, medical director of the USC Advanced Heart Failure Center, part of the USC Cardiac and Vascular Institute and Keck Medicine of USC, and a specialist in heart failure, transplant and mechanical circulatory support, explains, “‘Congestive heart failure’ is too limiting a term, and thinking of the condition more broadly just as ‘heart failure’ better represents what we’re seeing in the patients we treat.”

What is heart failure?

So what is heart failure?

Quite simply, heart failure is a heart’s inability to meet the body’s needs. The heart’s job is to pump blood throughout the body, and if it can’t accomplish that either because it doesn’t fill with blood or can’t squeeze it out sufficiently, then it’s failing that job.

Where does “congestive” come from?

“Congestion” enters the picture when the heart really starts falling behind in its blood-pumping duties.

Once that happens, fluid builds up in the vessels, increasing pressure on the lungs and surrounding tissues.

Eventually, all that pressure forces fluid out of the vessels and into the air sacs of the lungs — where it makes breathing difficult — and into tissues in the body’s periphery, where it swells the legs and feet, and even the abdomen.

It’s this buildup of fluid that doctors refer to as congestion.

Waiting for congestion may be waiting too long

The problem with focusing on congestion is that people can be at risk for heart failure — whether because they have coronary artery disease, high blood pressure, diabetes, metabolic syndrome or a family history of it — long before congestion or other symptoms appear.

And once congestion does appear, patients have already progressed to a later stage of heart failure.

Thus, says Dr. Vaidya, “Waiting for congestion before diagnosing people with heart failure prevents us from intervening and stabilizing their heart before they get symptoms of congestion. And we’d love to catch heart failure much earlier. If we’re waiting for symptoms to develop, then we’ve lost important time to intervene.”

What are the signs of heart failure?

Among the most common symptoms of heart failure doctors look out for are the following:

• Shortness of breath, particularly with activity
• Trouble breathing at night
• Inability to lay flat due to trouble breathing
• Waking up at night gasping for air
• Fatigue during activities of daily living
• Chest pain
• Heart palpitations
• Weight gain
• Swelling in the legs, feet and abdomen
• Firm bloating in the abdomen

But when you get down to it, Dr. Vaidya says, “If you’re feeling more limited doing things you were previously able to do, specifically because of breathing and fatigue, that’s a sign to be aware of.”

Diagnosing and treating heart failure

If a patient receives a heart-failure diagnosis, Dr. Vaidya continues, “Our job is to answer two questions: First, what caused this, and have we pursued the diagnostic testing to figure that out?”

Such testing might involve blood tests, chest X-rays, a heart MRI or CT scan, echocardiograms, electrocardiograms, stress tests, genetic tests and more.

“Secondly,” he says, “we have to ask which medical therapies, surgeries, procedures or devices have the best chance of stabilizing the heart failure and potentially recovering heart function over time.”

This is where a doctor will consider what stage a patient’s at in their heart failure, with those in the very early stages engaging in a treatment plan of regular exercise, improving their diets, quitting smoking and taking steps similar to those used for lowering high blood pressure and cholesterol.

In the most advanced cases, however, a technology called a left ventricular assist device (LVAD), which helps the heart pump better, or even a heart transplant may be in the plan.

Getting the care you need

All of which underscores the importance of getting optimal care.

“Heart failure can be a progressive disease that requires chronic management and the expertise of a well-known and comprehensive heart-failure program led by advanced heart-failure specialists like you’ll see at Keck Medicine,” Dr. Vaidya says. “We’re able to treat all stages of heart failure to give patients their best chance of stabilizing, slowing or even stopping its progression. And if the heart failure is severe or progressing rapidly, we have advanced therapies only offered at limited centers — like heart transplants and LVADs.”

But he’d rather avoid getting to that point in the first place.

“Prevention is better than cure, and we’re in the prevention business,” he says. “We want people to live as well and as long as possible, and approaching diseases at an earlier state gives us the highest chance for that.”

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