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Advanced Heart Failure

Overview

What are Advanced Heart Failure and Transplant?

As part of cardiology, advanced Heart Failure and Transplant is dedicated to the most complex and severe stages of heart disease. These stages are when the heart muscle is significantly weakened leading it to no longer being able to pump blood effectively to meet the body's needs.

Doctors and surgeons across this field manage progressive symptoms that persist despite standard medical therapy. Specialists in this area are experts in deploying advanced pharmacological strategies, sophisticated device therapies and surgical interventions, including heart transplantation and mechanical circulatory support.

Although extending life is one of its core aims, this specialty also looks to actively improve its quality. This is done through tailored management strategies for patients with advanced disease and supporting them and their families through a challenging journey.

Types of Advanced Heart Failure

To understand advanced heart failure, specialists look at the root cause and type of pumping problem. The first main type is known as heart failure with reduced ejection fraction. This is where the heart muscle becomes weak and cannot contract properly. The second is heart failure with preserved ejection fraction, which happens when the heart muscle stiffens and cannot relax and fill adequately.

Conditions leading to this advanced stage are varied. They include ischemic cardiomyopathy from long-standing coronary artery disease, dilated cardiomyopathy, where the heart becomes enlarged and weak and hypertrophic cardiomyopathy involving abnormal thickening of the heart muscle. Other contributors can be severe valvular heart disease, toxic or inflammatory damage to the heart muscle and complex congenital heart conditions.

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Recognising the signs that routine heart failure management is no longer sufficient is critical. Symptoms that should prompt consultation with an advanced heart failure specialist include persistent shortness of breath despite medication, especially at rest or when lying flat. Profound fatigue that limits all daily activities and swelling in the legs, ankles or abdomen that does not resolve should be investigated as soon as possible.

Other key indicators are recurrent hospitalisations for fluid overload, a progressive decline in kidney function or experiencing symptoms of low blood flow such as dizziness, confusion or cold extremities. If patients find that standard treatments are losing their effectiveness or their ability to perform basic tasks is deteriorating, it is time to seek the specialised care of an advanced heart failure clinic.

Diagnosis in this subspecialty involves a comprehensive assessment to understand the full extent of the heart's impairment and its systemic impact. Clinical evaluations are conducted to review the progression of symptoms, medication response and functional limitation.

Advanced imaging is the cornerstone. Echocardiograms are used to assess heart structure and function in detail, while cardiac MRI provides intricate tissue characterisation. An invasive procedure like right heart catheterisation is often essential in directly measuring pressures within the heart and lungs. Specific biomarkers are looked for during blood tests to help evaluate heart strain and other organ function. A multi-faceted approach like this at NMC allows our specialists to precisely stage the disease and formulate a targeted management plan.

  • Chronic advanced heart failure (stages C and D)
  • Cardiogenic shock and acutely decompensated heart failure.
  • Patients under evaluation for or living with mechanical circulatory support (e.g., Ventricular Assist Devices - VADs).
  • Patients pre- and post-heart transplant.
  • Secondary complex heart failure
  • End-stage right ventricular failure.
  • Management of pulmonary hypertension
  • Heart failure with preserved ejection fraction that is severely symptomatic.

Our advanced heart failure clinic in Dubai, Abu Dhabi, Sharjah, Ajman, Ras Al Khaimah, Al Ain and across the UAE is known for providing a coordinated, patient-centred approach. Treatment is personalised and follows a stepped pathway. We first optimise and maximise all advanced pharmacological heart failure treatment regimens. When medications are insufficient, we specialise in implanting and managing advanced device therapies, such as cardiac resynchronisation therapy and implantable cardioverter-defibrillators.

We evaluate and manage long-term mechanical circulatory support (VADs) for eligible patients with progressive disease. This can serve as a bridge to transplant or as a long-term solution. Our programme also provides comprehensive assessment and lifelong management for heart transplant for candidates that are suitable.

Our team, comprising dedicated heart failure specialist cardiologists, transplant surgeons, VAD coordinators, specialised nurses, dietitians, physiotherapists and pharmacists work as one team. We support patients from initial evaluation through intensive treatment and long-term follow-up, ensuring seamless care across the continuum. Whether patients are visiting our heart failure clinic in Dubai, Abu Dhabi, or anywhere across the UAE, they will have access to this integrated standard of expert care.

Our team consists of internationally trained and recognised consultants who are experts in the field of advanced heart failure and transplantation. They bring extensive experience from leading global centres to the UAE. Supported by a full multidisciplinary team, they are dedicated solely to this patient population.

Being faced with advanced heart disease is not only overwhelming, but it can also bring up existential questions. Understanding this, our consultants ensure transparency and empathy across all consultations, with an awareness of how emotionally difficult a diagnosis can be. Across the NMC hospitals and clinics in Dubai, Abu Dhabi, Sharjah, Ajman, Ras Al Khaimah and Al Ain, our specialists provide both exceptional clinical expertise and profound compassion. We help those seeking a heart failure specialist or guidance on heart transplant pathways across the UAE.

FAQs

Find the Answer to Your Medical Questions

Frequently Asked Questions

A heart transplant is considered for patients with end-stage, irreversible heart failure who have exhausted all other medical and surgical options. Especially those who continue to have severe symptoms and have a high risk of mortality within one to two years, but are otherwise healthy enough to undergo the procedure and commit to lifelong follow-up care.
With contemporary advanced therapies available at a dedicated heart failure clinic, including new medications, devices, VADs and transplantation, many patients can live significantly longer with a much-improved quality of life. Outcomes are highly individual. They depend on the specific cause, other health conditions and one’s response to treatment.
Absolutely not. Comprehensive medical management is always the foundation. The heart failure treatment plan is multi-modal, and our goal is to improve life with the least invasive, effective strategy. Only when essential, surgery or a transplant is considered.
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