Surgical treatments for advanced heart failure have come a long way—scientists have made major improvements that can help patients live longer than ever before.

But many of these therapies come with a risk for serious complications and can negatively impact quality of life—so they may add more years to a patient’s life, but will they be pleasant ones?

A panel of doctors supported by the American Heart Association recently published a statement regarding treatment decisions for advanced heart failure, including defibrillators, artificial heart pumps and bypass surgery.

They argue that these decisions are complex and need to be discussed in detail between patients and their health-care providers. So before you say “yes” to a new heart failure surgical treatment, there is important information to factor into your decision…

MORE YEARS DON’T ALWAYS MEAN GOOD YEARS

After reading the American Heart Association’s statement, I spoke with the cochair of the panel, Larry Allen, MD, MHS, a cardiologist at the University of Colorado School of Medicine in Denver. He briefly described some issues that patients will want to consider before proceeding with the following surgical treatments…

  • Implantable Cardioverter Defibrillator (ICD): This device helps prevent sudden death by using an electrical shock to get the heart out of a dangerously fast rhythm. But contrary to what you might think, it won’t ease the symptoms of heart failure, such as shortness of breath, excessive tiredness and swelling in the belly, legs, ankles and feet. The device can get confused (such as when a patient is exercising) and shock a patient when he doesn’t need to get shocked, which can be painful. It also can get infected and need to be replaced. And even if things go well, you still need to see your doctor at least a few times a year to make sure that the device is working properly.
  • Coronary Bypass Surgery: This open-heart surgery is designed to restore blood flow to the heart muscle, with the goal of reducing chest pain and/or improving heart-pumping function. Possible complications during surgery include bleeding, infection, heart arrhythmias, heart attack, kidney failure, temporary memory loss or trouble thinking, and stroke. Recovery tends to take six to 12 weeks, so you may have to take a few months off from working or doing most activities. And it doesn’t necessarily prevent arteries from clogging in the future.
  • Left Ventricular Assist Device (LVAD): This artificial heart pump, which helps the heart deliver oxygen-rich blood to the body, contains external cords and batteries, which typically need to be charged daily. The cords and the spot on the stomach where the main cord comes out of the body can’t be pulled on or gotten wet, so that means no contact sports, limited ways to bathe (only sponge baths or showers with precautions to keep the external cord dry) and no sleeping on your stomach. There can be malfunctions with the device after it’s implanted. Plus, it puts you at higher risk for internal bleeding and stroke (from blood thinners or from clots), both of which could cause death.

MAKING TOUGH DECISIONS EASIER

The challenge, Dr. Allen said, is weighing the benefits versus the risks and annoyances. Here’s what he recommends to any patient with heart failure…

  • Ask questions. If your doctor emphasizes only the potential “pros” of a treatment, ask that he or she detail all the potential “cons,” too.
  • Whether you go through with a surgical treatment or not, consider palliative care. When people hear the term “palliative care,” they typically relate it to “at death’s door.” But that is not always true. What palliative care for heart failure really means is managing (but not necessarily trying to cure) the symptoms of the condition and helping patients and families deal with the disease. Methods vary, depending on symptoms, but a heart failure patient receiving palliative care might be given a diuretic, antidepressant, pain reliever and/or other medications. Health-care providers might also arrange talk therapy, provide assistance with bathing and dressing, and/or give the patient an oxygen tank and/or a motorized wheelchair.
  • Get a second opinion. Most decisions about heart failure treatment are not unforeseen emergencies. Patients often have time to consult two doctors…or even three…before making a decision. Different doctors may be more “for” or more “against” certain treatments, and it’s helpful to hear their reasons. Hear them all out and decide for yourself.
  • Meet other patients. Having face-to-face conversations with patients who have undergone the same type of treatment that you’re considering is invaluable because you’ll get a realistic sense of what life after surgery might be like. Ask your doctor to introduce you to patients who have had the treatment and who are willing to meet with you. If your doctor can’t or won’t make such referrals, find a doctor who will. Online patient support groups are also available.