Some patients with advanced heart failure caused by cardiomyopathy, the deterioration of function of the heart muscle, are benefitting from a new recovery protocol at the University of Louisville and Jewish Hospital, a part of KentuckyOne Health.
Led by Emma Birks, M.D., Ph.D., FRCP, director of the Jewish Hospital Heart Failure, Transplant and Mechanical Support Program, the program treats advanced heart failure patients who have left ventricular assist devices (LVADs), also known as heart pumps, that help the heart function. Using a specific combination of medications - which includes ACE inhibitors, spironolactone, beta blockers, angiotensin receptor blockers and digoxin, in combination with the LVAD - the elements work together to strengthen the patients' hearts.
Birks, professor of medicine, physiology and biophysics at the UofL School of Medicine, monitors the patients closely, and once the heart function improves to normal levels, the LVAD is removed. Once the LVAD is removed, medication therapy remains ongoing for patients, but they are able to function normally and return to work and other daily activities.
"These patients have a very good quality of life, much better, in fact, than if they continued with the LVAD alone or received a heart transplant," Birks said.
The program has led to the successful removal of LVADs from 11 patients at Jewish Hospital in just 18 months. The only other center in the United States to have removed LVADs using this protocol is the Texas Heart Institute, where 20 devices have been removed in the last 10 years.
The average time on the medication before the LVAD is removed has been six months, but it can be more than a year.
"We don't rush it," Birks said. "The patients are closely monitored to determine the right timeframe."
Jewish Hospital is the second facility in the country to remove LVADs from patients using the protocol, which was pioneered in England by Birks and her mentor, a well-known heart surgeon, Dr. Magdi Yacoub.
Upon Yacoub's retirement, Birks carried forward the work he began in England in 1998, which led to the recovery protocol.