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By Sanjeev Gulati, MD

When a patient with advanced heart failure is on maximal therapy and their symptoms keep getting worse, it’s easy for providers to think they’re out of treatment options. But new therapies and devices can help patients with all classes of heart failure live active, fulfilling lives. Even patients with left ventricular assist devices (LVADs) can travel and play golf.

At Sanger Heart & Vascular Institute, we’re on a mission to help cardiologists bring the latest treatments to patients throughout our region. Here are two advances we’re especially excited about.

ARNI: More Effective Than ACE Inhibitors

Some patients with NYHA Class II-IV heart failure suffer persistent symptoms despite maximum amounts of ACE inhibitors. Fortunately, a new class of drugs – called angiotensin receptor-neprilysin inhibitors (ARNIs) – offer a more effective alternative.

ARNIs combine a traditional antiotensisn II receptor blocker (ARB) with an inhibitor that blocks neprilysin enzymes. The ARB enables blood vessels to dilate, while the neprilysin inhibitor boosts natriuretic peptide levels and improves blood flow.

A New England Journal of Medicine study showed that one ARNI combination, available as the drug Entresto, significantly reduces hospitalizations, all-cause mortality and cardiovascular death compared to an ACE inhibitor. The American College of Cardiology, American Heart Association and Heart Failure Society of America now recommend that patients with HFrEF take ARNI instead of ACE inhibitors or standalone ARBs. And patients can get ARNI from their primary care physician or cardiologist, enabling them to stay with familiar doctors.

The Latest LVADS: Portable, Effective and Reliable

Advanced heart failure care can prevent many patients from needing mechanical support or a heart transplant. But it’s time to explore advanced options if a patient with NYHA Class III or IV heart failure is on maximal therapy and still going in and out of the hospital, experiencing organ failure and/or getting less able to manage functional tasks.

The good news is, today’s left ventricular assist devices (LVADs) are more effective, portable and reliable than their predecessors. The new HeartMate 3 device is especially promising: It’s small enough to fit in a fanny pack and has a much lower risk of complications. Sanger participated in the recent MOMENTUM 3 trial, which showed that:

  • The HeartMate 3 is so reliable that fewer than one percent of MOMENTUM 3 participants needed to have their device replaced.
  • Participants using HeartMate 3 were half as likely to suffer a stroke as patients on HeartMate 2.

What’s more, patients using HeartMate 3 or other new LVADs can exercise, play golf and travel without worrying their device will fail.

Here at Sanger, we believe many more patients should be considered for LVADs instead of being consigned to sedentary lives. We can help you determine if your patient needs mechanical support and we offer the latest LVADs, including some that are in clinical trials.

It’s Almost Never Too Early for Advanced Heart Failure Care

Studies show that patients treated by advanced heart failure programs have fewer complications, shorter hospital stays and better outcomes. And the sooner a patient gets specialized treatment, the better – options can be limited if a patient is referred too late.

Our Advanced Heart Failure & Transplant program is home to some of the nation’s top experts and has some of the region’s best outcomes. We make care convenient by offering advanced heart failure treatment at several locations including Carolinas Medical Center, Northeast Hospital, Pineville and Greenville, South Carolina.

We can see most patients within 24 hours of referral, and our physicians and surgeons share their cell phone numbers and email addresses with referring providers, so we can work together to deliver the best possible care.

For more information, or to make a referral, call 877-999-7484.

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