For advanced heart failure patients, collaboration holds the key to finding the best therapeutic option, says Teresa De Marco, M.D., director of the Advanced Heart Failure and Pulmonary Hypertension programs and medical director of the Heart Transplant Program at UCSF Medical Center.
"It's important for us to individualize care through collaboration with interdisciplinary teams that consider both physical and psychosocial factors, and to effectively co-manage our patients with the referring physicians to assure optimal outcomes."
Dr. Teresa De Marco
She says the teams should include specialists, referring physicians, nurses, pharmacists, dietitians, social workers and physical therapists. The breadth of knowledge is what fosters the best choice from a full spectrum of approved therapies, including pharmacotherapy, electrical and mechanical circulatory devices, heart transplantation and combined organ transplantation.
De Marco says that when patients are referred early, these expert teams can sometimes delay disease progression with state-of-the-art treatments or experimental pharmacological and device trials that may not be available at other centers. "And when the disease advances to late-stage heart failure, we can draw on specialized experience and expertise to make sure each patient continues to get the best therapeutic option for their needs," she continues.
The programs available at UCSF include:
Multidisciplinary care and technical advances make mechanical circulatory support a viable option for an increasing number of patients as a short-term bridge to recovery, as a longer-term bridge to transplant or as destination therapy. This is especially so where teams have experience in nearly all FDA-approved devices and so can skillfully recommend the right approach and device for each patient. The HeartWare pump expands the menu of options.
Dr. Georg Wieselthaler
"It is smaller than any other pump, can be used on both the left and right sides of the heart and is easier and faster to implant than other devices," says Georg Wieselthaler, MD, surgical director of the Cardiac Transplantation and Mechanical Circulatory Support Program, who has implanted over 60 HeartWare devices. Wieselthaler co-invented this device and has performed seminal research on it in Europe.
He notes that the HeartWare device also has a visual display for physicians, which aids in monitoring during examination by showing flow curve and curve of the current, and that its ability to store and download data for up to 30 days facilitates diagnosis.
When transplant becomes an option, an academic medical center like UCSF offers the advantages of experience, enhanced access to organs and novel devices, state-of-the-art genetic testing and a full range of imaging modalities.
"The key, however, is referring early enough to give these patients a chance," says Wieselthaler. "Anyone with a worsening heart condition that might ultimately require cardiac transplant should be referred for consultation as soon as possible."
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