Modern Treatments Are Changing Expectations After Diagnosis, Cardiologist Says
by SHAYLYNN MARKS
When many patients first hear a heart failure diagnosis, the words themselves often carry more fear than clarity, shaped by decades-old images of severe illness and limited options.
Dr. Kollagunta Chandresekhar, a cardiologist and founder of KSC Cardiology in Winter Haven, says that understanding no longer reflects how heart failure is treated today. Advances in medication, technology and long-term care have changed what a diagnosis can mean for patients, allowing many to continue living active, engaged lives while managing a chronic condition.
“People hear the term heart failure and assume nothing can be done,” says Chandresekhar, who goes by Dr. Sekhar.
“That’s often not true anymore.”
Understanding Heart Failure Today
Heart failure is not a single disease, but a broad diagnosis that describes the heart’s inability to meet the body’s demands.
“Heart failure used to be thought of as a primary problem of a weak heart,” Sekhar says. “Now we realize that a good 50% of patients have a normal pumping heart, but yet the patient is in heart failure.”
In some patients, the heart muscle is weakened and cannot pump effectively. In others, the heart pumps normally but is stiff and unable to fill properly. Both scenarios can lead to symptoms such as shortness of breath, fatigue, and difficulty tolerating everyday activity.
What has shifted most over the past two decades is how physicians approach treatment.
“Twenty years ago, we were treating the symptoms, not the primary problem,” he says. “Taking fluid off helps patients breathe better, but it doesn’t explain why the heart is failing or what we can do to slow that process.”
With advances in medication and long-term management, heart failure is now more commonly treated as a chronic condition that can often be stabilized. Despite the diagnosis, many patients continue to work, exercise and remain engaged in daily life.
When Symptoms Are Easy to Miss
In one case, Sekhar described a patient who insisted he was doing well despite multiple hospitalizations.
“He told me he was fine,” Sekhar says. “But when I asked him about going to the store, he admitted that if he walked through a few aisles, he would have to sit down because he was out of breath.”
“That’s normal activity,” Sekhar Says. “If you get winded with that little activity, that’s a problem.”
Sekhar says those kinds of missed warning signs can delay meaningful treatment when declining function is dismissed as normal aging or an unavoidable part of heart disease.
“One of the biggest misconceptions is believing nothing can be done,” he says. “People assume feeling worse is just part of having a bad heart.”
Treatment Has Evolved
“There’s so much innovation and new things coming out for bad hearts,” Sekhar explains. “For a great majority of people, there are some options that are possible.”
For patients whose hearts become too weak despite medication, mechanical support devices known as left ventricular assist devices (LVADs), have also changed what long-term management can look like. Originally developed as a temporary bridge to transplant, LVADs can be used to help patients regain strength or maintain quality of life when transplant is not immediately pursued.
“If you’re below the age of 70, you have a decent chance of potentially getting a transplant,” Sekhar says. “Even if you may not need it, God willing, you don’t need it, you would be a candidate.”
He says early referral allows patients to be monitored closely and evaluated before their condition deteriorates.
“Part of the problem is waiting until the patient is so far gone,” he says. “If they come in on a ventilator or multiple drips, those become very difficult cases.”
Sekhar emphasizes that timing and treatment decisions are ultimately collaborative.
“There’s no right or wrong,” he says. “Patients may feel fine and not want to rush, and transplant programs worry about waiting too long. It has to be a shared decision.”
Mental Health Challenges
“A lot of people with bad hearts tend to get depressed, and it’s extremely common,” he says. “They worry that one day they’re going to drop dead, or that they won’t be there for their family.”
He says those feelings are frequently compounded by stigma amongst those who may be reluctant to admit emotional distress.
“A lot of times they don’t like to mention that they feel depressed,” Sekhar says. “They feel like saying that is beneath what they should be able to handle.”
Sekhar says untreated depression can worsen outcomes for patients with heart failure if emotional distress goes unrecognized or unaddressed.
“Mental health is a big part of heart disease,” he says. “Not everybody asks those questions, but they matter.”
What Patients Can Control
“Physical activity is important, not just for the heart, but for the whole body,” Sekhar says. “It helps build stamina and prepares patients if they ever need advanced treatment.”
He also cautions that stopping medications once symptoms improve is another common and dangerous misunderstanding.
“This is a chronic condition,” he says. “People feel better and think they don’t need their medicines anymore, but the heart is better because of the treatment.”
Despite the challenges heart failure can present, a diagnosis doesn’t define a patient’s future.
“There is always hope,” he says. “There are always other things we can try to keep people going and help them live better.”