Heart failure is a condition that affects the heart’s ability to pump blood. The heart may be too weak to pump blood through the aorta and on to the body; or the chambers of the heart may not fill with enough blood. In either case, the tissues of the body don’t get enough oxygen and blood flow backs up. The heart may try to compensate by pumping harder or faster. The extra work causes the heart muscle to enlarge, which further inhibits its ability to pump efficiently.

The National Heart, Lung and Blood Institute estimates about 5 million Americans have heart failure. Every year, 550,000 new cases are diagnosed and 300,000 people die of the condition. In most cases, the heart is weakened from coronary artery disease, high blood pressure or diabetes. Some other causes of heart failure include: heart valve disease, infection or disease of the heart muscle, congenital heart defects, arrhythmias and severe lung disease.

Treating Heart Failure

Patients with heart failure need to adopt a healthy lifestyle to reduce stress on the heart and alleviate symptoms. Medications may be prescribed to reduce build-up of fluid, open the blood vessels, and/or improve the pumping ability of the heart muscle. For patients with underlying coronary artery disease, bypass surgery may help improve blood flow through the heart muscle. Those with irregular heart beats may need a pacemaker or implantable defibrillator.

Patients with severe heart failure may require a heart transplant. If a heart is not immediately available, a left ventricular assist device (LVAD) may be implanted. An LVAD is a mechanical device that helps pump blood from the left ventricle of the heart (the main pumping chamber) to the body. For many patients, the LVAD can buy some time, providing an assist for the severely weakened heart until a donor heart becomes available. This is called a bridge to transplant. In some cases, the heart needs just enough help until it can recover from an illness or infection. For these patients, an LVAD may provide enough temporary support for the heart to recover. Then the LVAD is removed. This is a bridge to recovery. In a very small number of patients (such as those who are ineligible for a heart transplant), an LVAD is a permanent device.

Recovery for Severe Heart Failure

Most patients with severe heart failure need a heart transplant to survive. However, researchers believe that even some of these patients may be able to recover if they are provided with the right treatment and support. But after prolonged use of an LVAD, the heart muscle atrophies, or shrinks.

Investigators believe a drug, called Clenbuterol, may allow a weak, atrophied heart muscle to regain strength after LVAD placement. Clenbuterol is used in veterinary medicine to ease breathing in horses. It also stimulates growth of heart muscle cells.

In a small European study, a group of heart failure patients was given a combination of LVAD, traditional heart failure medications and Clenbuterol. Investigators found 73 percent of the patients had sufficient heart muscle recovery to enable doctors to remove the LVAD. All the survivors were still free of heart failure one year after removal of the LVAD. Four years after removal, nearly 90 percent still had no recurrence of the heart failure.

Researchers in the U.S. are now trying to duplicate the European results. The trial, called the “Harefield Recovery Protocol Study” (HARPS), will enroll 40 patients who have had severe heart failure for at least 12 months and need a heart transplant and/or LVAD therapy. Once enrolled, participants will receive the LVAD and be given large doses of standard heart failure medications. At the same time, participants will be given Clenbuterol to stimulate the growth of heart muscle cells and hopefully, restore the heart’s strength. Hopefully, the LVAD and medications will improve heart function and give the heart time to rest and recover.

In addition to the University of Michigan, the HARPS study is taking place at the following sites:
Northwestern University, Chicago, IL
Montefiore Medical Center, Bronx, NY
Ohio State University, Columbus, OH
University of Pennsylvania, Philadelphia, PA
Texas Heart Institute, Houston, TX
Georgetown Hospital, Washington, DC

Researchers are still looking for participants. For information about the study, go to http://www.clinicaltrials.gov. Then type the trial ID number in the search box: NCT00585546. For information about the study, go to http://www.clinicaltrials.gov. Then type the trial ID number in the search box: NCT00585546.

For information on heart failure or left ventricular assist devices (LVADs):

American Heart Association

National Heart, Lung and Blood Institute