'A nice problem to have': Dr. Howard Eisen on plethora of therapies for heart failure

Howard Eisen, MD, medical director of the advanced heart failure, cardiac transplant and mechanical circulatory support programs at Milton S. Hershey (Pa.) Medical Center, outlined several key questions about heart failure treatment that leaders are currently grappling with during a recent episode of the Becker's Healthcare cardiology podcast.

Here is an excerpt from the podcast. Click here to download the full episode.

Editor's note: This response was lightly edited for length and clarity.

Dr. Howard Eisen: It's really an exciting time in heart failure because we have a lot of excellent new therapies. Some of them are medical therapies; some of them are new devices. It may prevent us from actually needing to put ventricular assist devices or doing transplants because patients may get better with medical therapy. And certainly I've seen that in my practice. So the real question is how do we integrate newer therapies into our approach? Right now, we have a fairly regimented, guideline-driven approach. It's kind of a nice problem to have a lot of new therapies. 

Another issue is how do we get patients referred earlier rather than later for some of the therapies we have for advanced heart failure, specifically ventricular assist devices and transplants? We know that the earlier these patients are referred the better their outcomes. I think a lot of that will involve discussions with referring physicians and education.

The final issue [focuses on how] we integrate some of the less invasive therapies for structural heart disease. We have all these percutaneous therapies, and they're very successful, but the question is, how do we use this as opposed to surgery? We know when to use these therapies in older sicker patients, but, for example, when do we use them in heart failure patients? 

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