Can heart failure be reversed?

Heart failure is a serious chronic condition that weakens your heart. It decreases the amount of blood that the heart can deliver to organs and the rest of the body. One in four people will develop heart failure in their lifetime. Can this condition be reversed?

Imad Hariri, MD, is a ProMedica Physician cardiologist who specializes in advanced heart failure and transplant cardiology. He says that while completely reversing heart failure is not possible, with the right treatment, it’s possible to improve the heart function and make heart failure in remission.

Learn more in our Q&A with Dr. Hariri below.

How does heart failure develop?

Heart failure can slowly develop over time, or it can come about quickly.

Although it’s a chronic condition, sometimes heart failure can present in a way that we call “acute” because of its sudden onset. For instance, some people may develop acute heart failure after a massive heart attack, an arrhythmia event or even after viral illness.

Some patients may present in a state of “shock” called cardiogenic shock (when their weak heart is unable to keep up with the needs of the body). This can happen after a valve rupture or after certain inflammatory conditions that can the affect the heart, like viruses, which we saw a lot of during the COVID pandemic.

How serious is heart failure?

People sometimes underestimate the severity of their heart failing and what that means for their livelihood. We know that survival in patients with heart failure can be far lower than a lot of cancers. It’s great that people are aware of cancer and its prevention; we need that same awareness and focus on heart failure.

Heart failure increases fluid buildup in our “pipes,” like congestion in the lungs, and swelling in the abdomen and legs. It can be more deadly than a lot of cancers. Cardiovascular disease is the No. 1 cause of mortality, or death, in the United States. People die because their heart fails. They have a lot of congestion and fluid overload, shortness of breath, fatigue, swelling and a poor appetite.

Can heart failure be reversed?

Heart failure is a chronic condition that has no cure. The good news is that advances in medications and device therapies have improved the quality of life of patients.

Remember that “heart failure” is a broad term that encompasses a wide variety of conditions that can lead to a weakness in the heart muscle. In some cases, like for patients who have a rhythm abnormality that causes a heart muscle dysfunction, restoring the normal heart rhythm can improve heart function. Other scenarios, such as heart failure caused by medication or related to alcohol use, can also be reversible if the condition is diagnosed early.

As a community, cardiologists now think of heart failure like cancers, which are chronic conditions that can go into remission. 

What kind of lifestyle changes can make an impact on heart failure?

One of the things we focus on when treating heart failure patients is having lifestyle changes at the center of our management. Small changes in a patient’s lifestyle can have an added effect on medical therapy.

We typically recommend physician-supervised cardiac rehab programs that offer not only exercise training, but also dietary counseling. In general, we recommend a heart-healthy diet rich in vegetables, grains and lean meats.

At the crux of dietary changes, is an attention to the amount of fluids and the amount of sodium patients consume in their diet. The jury is out on whether strict restriction of sodium intake affects clinical outcomes. However, we know that patients are able to better manage their symptoms when they consciously limit their sodium intake. It’s not just using a saltshaker; it’s looking at food labels and limiting how often you eat out. An education session about how sodium hides in our diet goes a long way.

What is a cardiac rehab program like?

These programs typically start with supervised exercise. Patients get hooked up to the cardiac equipment so we know what their heart is doing. We have an exercise prescription for them and we know how to push them in a way that is safe for their heart.

I tell my patients: I’m not asking you to go run a marathon. Start slow and build up from there.

Can stress affect heart failure, too?

Stress leads to the release of hormones that actually impact the heart directly. Something you may have heard of is broken heart syndrome, which is what we now call stress-mediated cardiomyopathy. So, absolutely, stress can lead to heart failure.

One of the ways we treat heart failure is by decreasing the amount of these hormones through medications.

How does medication help manage heart failure?

We cannot overstate the impact of medications on outcomes for heart failure patients. The current medication regimen consists of four medications, which we now call the four pillars of heart failure therapy. These have been shown to not only make patients feel better, but to also help them live longer and stay out of the hospital.

These four classes of medications that are generally recommended include beta-blockers, renin-angiotensin inhibitors (ACEi, ARBs, ARNIs), mineralocorticoid receptor antagonists (MRAs), and SGLT2-inhibitors.

These medications also prevent the recurrence of heart failure events. Some studies have shown that patients who stopped these medications ended up doing worse in the future.

Are some patients hesitant to take heart failure medications?

I find that when people understand why they’re on medication and I explain it to them, they actually see the value in it.

One of the biggest obstacles to getting people on medications has been the cost. Unfortunately, a lot of these medications are new medications and come at a higher cost. So we’ve really championed for patients in the last couple of years. We’ve found resources for them to get medications at a discount or free; we apply for patient assistance, and provide resources and grants to get them medications.

We’re proud of the work we’ve done at ProMedica to get to the bottom of heart failure care, starting in the community. We've instituted a mobile platform where we communicate with our patients through messages, and we send them digital scales and blood pressure cuffs to have more direct care at home. We have also partnered with pharmacists from the Jobst Vascular Institute to help take care of patients with heart failure.

How does ProMedica’s program impact patients?

We know that getting patients on the right medications truly saves lives. We have been proud of the work our heart failure team has done over the years and have managed to institute a robust medication titration program which has effectively allowed us to have more than 90% of our patients on three of the four pillars of medical therapy for heart failure. This is well above the national average.

We know that translates to a lower rate of rehospitalization and, more importantly, an improved quality of life for our patients. ProMedica has been at the forefront of heart failure care in the region. We are pleased to be able to serve our patients in our heart failure clinics.

If medications are not enough, can procedures or devices help with heart failure?

When medications are not sufficient, we sometimes turn to devices and procedures to help improve the lives of patients with heart failure.

For patients who have heart electrical conduction abnormalities, devices like cardiac resynchronization therapy (a pacemaker of the lower two heart chambers) can improve symptoms and survival. Additionally, non-surgical repair of the heart valves has also been shown to be beneficial for some with heart failure. This may include catheters and devices to fix valves and try to improve heart function.

In extreme cases, when patients have difficulty controlling heart failure that jeopardizes their survival, select patients may be candidates for implantable mechanical heart pumps (LVADs) or a heart transplant.

Imad Hariri, MD
Imad Hariri, MD is a cardiologist with ProMedica Physicians. View his profile.