By definition, heart failure is the inability of the heart to circulate blood effectively to the body. The ejection fraction (EF) measures how much blood the heart pumps with each beat. A normal EF is 50% or higher.
Heart failure can occur because of reduced pumping ability (known as heart failure with reduced ejection fraction) or because the heart cannot fill appropriately (heart failure with preserved ejection fraction). While there are many causes of heart failure, the two most common are coronary artery disease and idiopathic dilated cardiomyopathy.
Symptoms may include shortness of breath, needing to sleep propped up or with multiple pillows, waking at night due to shortness of breath, fatigue and swelling or edema. Some symptoms can be nonspecific, so a physical exam and additional testing are often necessary for diagnosis. Standard testing may include lab work, chest X-ray, EKG, echocardiogram and evaluation for ischemia.
Heart failure is a prevalent and serious condition. More than 6.7 million people in the United States are currently living with it. That number is expected to exceed 8 million by 2030 — just five years away.
Heart failure carries a 50% five-year mortality rate, making it a critical diagnosis. However, medical therapy can be lifesaving. According to the National Institutes of Health, for patients with heart failure and a reduced ejection fraction (EF), optimal, guideline-directed medical therapy can reduce mortality by more than 70%, while also improving quality of life. Unfortunately, only about 1% of heart failure patients are on this optimal therapy. We aim to change that.
The Heart Failure Therapy Clinic was first established at Northside Hospital Forsyth in 2013 to enhance both the quality and quantity of life for patients with heart failure. The program has since expanded to Northside Hospital Atlanta, Cherokee and Gwinnett.
The clinic is designed to optimize care and prevent hospital admissions and readmissions. It includes both inpatient and outpatient components, led by advanced practice providers experienced in heart failure management, with oversight by advanced heart failure and transplant physicians.
Inpatient services focus on optimizing volume status and initiating or adjusting medications. At Northside Gwinnett, nurse navigators provide education, help with discharge medications and support the transition to outpatient care. A medication bed program allows prescriptions to be filled at discharge, preventing delays in access to essential medicines.
The first month after discharge is especially vulnerable for heart failure patients. Telemonitoring is available for 30 days post-discharge to support medication reconciliation, monitor daily weight and blood pressure, and adjust diuretics as needed. Patients can also reach out with questions or concerns during this period.
The outpatient heart failure clinic offers close follow-up and works in coordination with each patient’s primary cardiologist and primary care provider. Medications are aggressively titrated, and point-of-care lab results are used to make timely treatment decisions. Intravenous diuretics can be administered as needed.
Patients are screened for sleep apnea and depression — conditions that can worsen heart failure — and referred for treatment when necessary. Additional support includes social work, dietary consults and coordination with cardiac rehabilitation programs. Education is provided using modules from the Heart Failure Society of America.
Progress is tracked through six-minute walk tests and the Minnesota Living with Heart Failure Questionnaire. The clinic also facilitates referrals for advanced therapies, including biventricular pacemakers, implantable cardioverter-defibrillators, valvular procedures, and, when necessary, transplant or LVAD (left ventricular assist device) evaluation.
Our clinics provide comprehensive heart failure care. If you are living with heart failure, know that we are here to help.
Learn more about Northside Hospital Heart Institute.
