How We Treat Heart Failure

NewYork-Presbyterian provides medical, surgical, and supportive therapies for people with all stages of heart failure. Your treatment may include one or more of these treatments.

Heart Failure Monitoring

NewYork-Presbyterian incorporates the CardioMEMS™ Heart Failure System into our comprehensive care of people with heart failure. This cutting-edge tool allows continuous monitoring of your pulmonary pressure, enabling us to recognize fluid accumulation earlier and allowing for quicker intervention or adjustment of medications before your symptoms get so severe that you need to come to the emergency room or be admitted to the hospital. CardioMEMS is the first and only FDA-approved heart failure monitoring system proven to significantly reduce hospital admissions and improve the quality of life.

Medical Therapies

We may treat your heart failure with drugs such as:

  • Sacubitril/Valsartan, the newest heart failure medicine to hit the market, works as an angiotensin receptor blocker (ARB) and a neprilysin inhibitor to help relax blood vessels and reduce sodium and water retention
  • ACE (angiotensin-converting enzyme) inhibitors, which help blood vessels dilate and help your body eliminate excess water, lowering the amount of work your heart has to do
  • Beta blockers, sometimes used with ACE inhibitors, may slow your heart rate and relax thickened heart muscle
  • Ivabradine is a medication used to reduce heart rate in heart failure patients in whom beta blockade only is not sufficient
  • Digitalis, which increases the force of each heart beat and slows a heart rate that is too fast
  • Diuretics, which help your body eliminate excess water and reduce blood pressure
  • Investigational therapies, such as stem cell, gene therapies, novel medical approaches to particular types of heart failure or heart failure associated with specifica medical problems (rheumatological, oncological)
  • Targeted exercise programs

If your heart failure gets worse despite these treatments, your body's tissues fail to get the nutrients and oxygen they need. In that case, you will need other treatment such as a heart transplant, a ventricular assist device (VAD), or extracorporeal membrane oxygenation (ECMO).

Heart Transplantation

Doctors in our Heart Failure and Transplantation Program are making continuous advances in medical therapies, surgical techniques, immunologic therapies, imaging methods, and device development. Our program's innovations include

  • The first successful pediatric heart transplant, in 1984.
  • The development of new ventricular assist device technologies.
  • The improvement of methods to prevent organ rejection after transplantation.
  • The implementation of new criteria to improve access to heart transplantation, particularly for very ill patients and those over age 65.
  • The assessment of investigational gene therapy to treat heart failure.

The heart transplant team at NewYork-Presbyterian expanded the usual criteria by which donor hearts are accepted. As a result, waiting times for a heart transplant are lower here than at other centers in the region; the ability to transplant sooner translates into better outcomes for our patients.

Our team pays attention to your quality of life during the entire transplant process, your evaluation as a transplant candidate, your surgical care in the hospital, and your follow-up treatments as a transplant recipient. We also perform combination heart and lung transplantation in people who need both surgeries.

Ventricular Assist Devices (VADs)

Illustration of how the Ventricular Assist Device works when connected to heart

(click to enlarge)
(credit: Thoratec Corporation)

Your left ventricle is the chamber responsible for pumping oxygen-rich blood from your heart to your aorta to be transported to the rest of your body. VADs help people with heart failure by taking on the workload of the left ventricle, helping your heart to pump oxygenated blood to the rest of your body. As a result, all of your tissues and organs receive the blood supply they need to do their jobs, and you feel better. VADs consist of three main parts: an electric pump, an electronic control system, and a power supply.

  • The electric pump is implanted in the upper part of your abdominal wall and connected to your heart at two points. A tube carries blood from your left ventricle to the pump. Your blood is then pumped through a second tube to your aorta, and distributed throughout your body.
  • The electronic control system is the "brain" of the VAD and controls its functioning. It is worn outside of your body and connected to a tube (with wires inside) that goes into your body and is connected to the electric pump.
  • The power supply (rechargeable batteries) is connected to the electronic control system and powers the VAD. You wear the electronic control system on a belt and the batteries on a vest-like shoulder holster.

Extracorporeal Membrane Oxygenation (ECMO)

ECMO is used to support patients with advanced heart or lung or circulatory failure until a patient recovers or is able to receive further treatment such as left ventricular assist device or heart transplantation. An ECMO circuit consists of a motorized pump and gas exchange membrane that allows blood to be oxygenated outside the body (or extracorporally) while carbon dioxide is also removed. By temporarily taking over the function of heart or lungs, ECMO helps ensure that the brain and other vital organs receive enough oxygen when a patient is most critically ill.

NewYork-Presbyterian's ECMO program at Columbia University is one of the most experienced and innovative programs in the world. Our ECMO program is one of five adult ECMO centers in the world designated a Platinum Level Center of Excellence by the Extracorporeal Life Support Organization (ELSO) for Excellence in Life Support. This prestigious designation is recognition of the exceptional, multidisciplinary patient care delivered to patients with advanced heart or lung failure at NewYork-Presbyterian.

NewYork-Presbyterian's ECMO program at Columbia University is one of three adult ECMO centers in the world designated a Platinum Center of Excellence by the Extracorporeal Life Support Organization (ELSO) for Excellence in Life Support.