Our Mission
Our program is dedicated to the treatment of heart failure with a multi-disciplinary approach that includes:
1. early and accurate diagnosis
2. state-of-the-art (evidence-based) treatment with proactive case management and monitoring
3. patient education with counseling about effective lifestyle changes that can assist with improving symptoms and prolonging life, and
4. clinical trials with FDA-approved medications and/or devices.
The Heart Failure Center
Welcome to the Heart Failure Center
at Hackensack University Medical Center.
Program participants are empowered to:
live as independently and comfortably as possible
maintain optimal cardiovascular health
prevent or halt progression of their disease
learn the tools that help them manage their disease
improve their quality of life, and
reduce hospitalizations due to their illness.
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Full Continuity of Specialized Care
A full continuity of specialized care is available for both inpatients and outpatients through the program. Inpatients are referred for bedside education and counseling. Upon discharge, patients who are eligible for services through HUMC’s Home Care Department will have nurse specialists from the program visit them for home management of their disease, which may also include intravenous (I.V.) medication. Once patients are mobile, they can access the full range of treatment, monitoring and counseling services at our outpatient center.
What is Heart Failure?
A diagnosis of heart failure does not mean that your heart is going to stop working or that you are about to die. Rather, heart failure is a common, chronic condition that occurs when your heart has become weakened due to injury to the heart muscle ( see
Causes of Heart Failure
). If you have this condition, your heart pumps too little blood to meet your body’s needs.
Why is good blood circulation important?
Blood is rich with oxygen and nutrients that keep our cells alive and functioning, so a strong circulation of blood throughout the body is vital to staying alive. When the heart is strong and healthy, it continuously pumps blood to nourish and energize the body.
How does the heart control blood circulation?
The heart is a muscular pump that serves as the master control station for blood circulation. The heart is divided into 4 chambers.
The upper chambers are called the right and left atrium,
and the lower chambers are called the right and left ventricle.
Blood from all parts of the body drains into the right atrium, passes through a valve and reaches the right ventricle. The right ventricle contracts with each heartbeat and blood is pushed into the lungs, where it gives off carbon dioxide, takes up oxygen and returns via the pulmonary veins to the left atrium. During relaxation of the left ventricle, the blood passes from the left atrium to the left ventricle where, with each heartbeat, it is ejected through the aortic valve
into the aorta.
How does the healthy heart circulate blood?
Normally, this powerful muscle pumps 5 to 6 quarts of blood per minute during rest and more than 20 quarts per minute during exercise, such as walking or climbing stairs. When healthy, the heart automatically adjusts to the changing demands of exercise by pumping faster and more forcefully, which brings more nourishment and energy to the muscles and organs.
How does the weak heart affect blood circulation?
When the heart is weak, its pumping power is diminished and blood circulation is decreased. The body does not get the full supply of oxygen that it needs to thrive. When this happens, your heart must work even harder to keep up with the demands of the body, and, as a result, many heart failure patients experience extreme fatigue and exhaustion. ( See
Symptoms of Heart Failure.
)
Types of Heart Failure
There are two distinct types of heart failure that can occur alone or together:
Systolic Dysfunction
(impaired contraction)
Systolic heart failure is caused by a weakened heart muscle that cannot contract with enough force to cause blood to flow out of the heart and into the bloodstream. In this case, blood coming into the heart from the lungs may back up and cause fluid to accumulate in the lungs and other parts of the body. Many people with heart failure have a buildup of fluid in the lungs, which is why you often hear the term “congestive” heart failure.
Diastolic Dysfunction
(impaired relaxation)
Diastolic heart failure occurs because the heart muscle is stiff and unable to receive blood during the relaxation phase of the cardiac cycle. This leads to similar symptoms of congestion as described above.
Symptoms of Heart Failure
When the heart pumps with less power and force than normal and cannot pump enough blood to organs and muscles, the symptoms of heart failure occur. Blood and fluids may collect or pool in the lungs, which can cause breathing problems when you lie down. Fluids can also collect in other parts of the body, swelling the feet, ankles, legs or abdomen. Most common symptoms include:
Breathing Difficulties
(shortness of breath from simple activities, trouble breathing when resting or lying down, waking up breathless at night, needing more than 2 pillows to sleep)
Tiredness/Exercise Intolerance
(getting tired easily, general feeling of exhaustion and weakness)
Fluid Retention
(swollen feet, ankles, and legs; nausea; abdominal swelling, pain and tenderness; weight gain from fluid build-up)
Coughing
(frequent coughing, coughing that produces mucus, dry cough when lying flat in bed)
Causes of Heart Failure
Although heart failure may strike at any age, it is more common in people over the age of 65. The risk of developing heart failure increases with age and with several other factors. The most common causes and risk factors of heart failure are:
high blood pressure
coronary artery disease
heart attack
heart muscle disorders, such as coronary artery disease cardiomyopathy
damage to the heart valves or history of a heart murmur
enlargement of the heart
diabetes.
Sometimes, the exact cause of heart failure cannot be found. However, the actual cause is not as important as diagnosing your heart’s reduced pumping power and learning how to manage your disease.
Learning to Live with Heart Failure
Learning to manage heart failure will reduce symptoms and improve how you feel. If you have been diagnosed with heart failure, there are many things that you can do to help yourself: The following recommendations should be included in your treatment plan:
Dietary Changes
Restriction of Sodium:
Limiting your intake of salt is very important because sodium attracts water and makes the body hold fluid.
Limitation of Fluids:
Limitation of fluids is important because your body already holds too much fluid, which leads to swelling. To pump the extra fluid from your body, the heart must work harder.
Charting your Weight
It is important for you to weigh yourself every day and contact your healthcare provider if your weight changes significantly since this is a sign of excessive fluid retention.
Low-Level Exercise
Exercising at levels recommended by your physician is of great importance in keeping you fit and improving your symptoms. Exercise strengthens your heart so it can pump more effectively.
Rest
During rest times, your heart pumps more easily, so you should plan to rest off and on throughout your day. It may help to take an afternoon nap or put your feet up for a few minutes every couple of hours.
Medications
Taking your medications as prescribed helps your heart work at its best. (See
Medications to Treat Heart Failure.
)
Medical Supervision
It is important for you to visit your physician frequently and notify him or her if there are any changes in your symptoms.
Stress Management
Since stress makes the heart work harder, try to find ways that help you cope with your stress and deal with your feelings.
Family Support
It is essential that both you and your family understand what heart failure is, what the symptoms are, what you should do if your symptoms change and how your physician is treating your disease.
For more information, click here to visit the American Heart Association's web page on
Living with Heart Failure
Medications to Treat Heart Failure
In addition to the lifestyle changes described above ( see
Learning to Live with Heart Failure
), the cornerstone treatment for heart failure generally includes prescribed medications to help the heart pump as efficiently as possible. Some of the more common medications used to treat heart failure include:
ACE Inhibitors or AR Blockers
Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin-receptor blockers (ARB) work by relaxing your blood vessels and lowering blood pressure, making your heart’s workload easier over time. These drugs inhibit or block the body’s reaction to angiotensin, which is a hormone that tightens the arteries. They have become the mainstay treatment for congestive heart failure, and they are usually the first lines of defense for those just diagnosed with this condition.
Diuretics
Diuretics, often called water pills, allow your heart to pump more efficiently by limiting the amount of fluid you retain and decreasing the fluid in your lungs so that you can breathe easier. This medication makes you urinate more frequently, and, as a result, your body loses potassium and magnesium. Your doctor may prescribe supplements of these minerals and monitor this side effect by ordering regular blood tests to check your levels of potassium and magnesium.
Spironolactone (Aldactone®)
Spironolactone (Aldactone®) is a type of diuretic that limits the amount of potassium that is lost during frequent urination and blocks aldosterone, a hormone that is often too high in heart failure patients.
Digoxin
Also referred to as digitalis, this drug increases the strength of your heart muscle contractions so more blood is pumped with each beat. It also tends to slow the heart rate and helps the kidneys work better.
Beta-Blockers
Beta-blockers slow your heart rate and reduce blood pressure by blocking many of the effects of the hormone adrenaline. These medicines also reduce the risk of some abnormal heart rhythms.
How We Can Help You
The medical center's heart failure program serves as a supplemental part of your overall medical plan while you continue to be under the care of your primary physician. The physicians and nurses of the program maintain communication with your referring physician to keep him or her informed about your condition. It does not replace your routine medical care; rather, it is an additional step that you can take to manage your illness better and improve your quality of life.
Early and Accurate Diagnosis
Early diagnosis is very important because heart failure that is left untreated can cause irreversible progression of the disease. Once accurately diagnosed, doctors have effective treatment options that help heart failure patients prevent or halt progression of their disease, improve their quality of life and reduce hospitalizations.
A delay in diagnosis often occurs when heart failure symptoms, such as feeling tired and short of breath, are mistaken as normal signs of aging. Sometimes, the early signs of heart failure are even misdiagnosed by experienced healthcare professionals because the body’s natural defense mechanisms mask the symptoms.
Heart failure symptoms are masked when the heart:
attempts to compensate by beating more rapidly (to increase circulation)
thickens (to increase the force of contraction)
enlarges (to allow more blood into the heart).
These compensatory mechanisms do not prevent worsening of the underlying disease and are very detrimental to the patient’s heart.
Benefits of BNP blood testing include:
provides a definitive diagnosis for patients with dyspnea (difficulty breathing or breathlessness) and edema (swelling), symptoms that have a broad range of differential diagnoses (indications of other diseases)
determines the severity of heart failure, which makes it extremely useful in the ongoing management of the disease. BNP concentrations increase with the severity of the disease.
rapid point of care testing enables results in 15 minutes.
State-of-the-Art (Evidence-Based) Treatment
The program is a dedicated center of excellence at Hackensack University Medical Center that focuses on bringing the latest advances in the treatment of heart failure to its patients. The physicians and staff members are leaders in the field of cardiology who specialize in heart failure.
Once you are accurately diagnosed, an appropriate treatment plan will be developed that includes medication, diet and exercise. The goal of treatment is to improve symptoms, prevent progression of the disease and improve quality of life and longevity.
Clinical Research Studies with FDA-Approved Medications and/or Devices
We are actively involved with the Division of Cardiac Services’ Clinical Cardiovascular Research efforts. Clinical trials with FDA-approved medications and/or devices for heart failure are currently being conducted and participants are being recruited for these studies. ( For more information on participating in a clinical research study, see
Clinical Cardiovascular Research.
)
Proactive Case Management & Monitoring
Our healthcare professionals closely monitor the course of your disease through proactive case management. This means that you have the benefit of a one-on-one relationship with a nurse specialist who will help you manage your disease and coordinate your care. This is especially important for older patients who sometimes have difficulty remembering when to take their medication, are confused by the guidelines for their treatment plan, or are unaware of early warning signs that indicate complications of their disease.
Varied Levels of Care:
Most heart failure patients require follow-up care that includes counseling regarding lifestyle changes and education about appropriate food choices. There are times when others with an unstable course of events require an intense follow-up plan to monitor heart function, either temporarily or long-term. This follow-up plan can include:
Monitoring by the heart failure program during an unstable course of events can help patients avoid hospitalizations and/or Emergency Room (ER) visits. Examples of the times when an intense monitoring schedule is helpful for heart failure patients include:
during changes in medication when weekly monitoring or more frequent visits are recommended to ensure that the new drug(s) are working well
during times of excessive fluid retention when the program can provide the administration of intravenous (I.V.) diuretics
the weeks following hospitalization for heart failure, especially when the patient is not eligible for home care, or
whenever an unstable course of heart failure symptoms develops.
One-to-One Educational Counseling
Educational counseling is an important
part of successful heart failure management.
Education, Counseling and Support Groups
Learning how to manage heart failure will improve your overall quality of life. Also, the number of hospitalizations and/or ER visits can be reduced with close monitoring. The program's nurse specialists and registered dietitians will teach you strategies to effectively manage your disease and will help you incorporate them into your daily life. Important educational topics include:
following your physician’s advice
recognizing and monitoring symptoms
learning about the medications prescribed for heart failure
medication compliance
monitoring daily weight
making proper food choices and other dietary changes
managing stress
getting enough rest, and
maintaining a low-level exercise routine.
Support Groups:
Support Groups are a great source of comfort and encouragement for many patients. They serve as a forum during which patients and family members can share the challenges facing them and the coping skills that have helped them. The medical center's heart failure program hosts Support Group meetings every 2 to 3 months.
During these meetings a nurse, registered dietitian and pharmacist present topics relating to heart failure and a social worker leads group discussion on living with this chronic disease. Participation in a support group does not require physician referral. To inquire about the date for an upcoming Support Group meeting, call 201-996-4849.
How to Enroll in the Program
If you are interested in enrolling in the program, you should first discuss it with your physician who will evaluate whether participation is appropriate for you. Once your physician recommends participation, you can register by calling 201-996-4849. Our professional staff will work with your physician to develop a treatment plan for your care.
Most insurance plans, including Medicare, cover participation. Depending upon your insurance plan, a referral may be needed from your physician to obtain coverage. We will be more than happy to assist you with any questions regarding coordination of your benefits and payment terms. For help with these matters, call 201-996-4849.
live as independently and comfortably as possible
