Heart failure is a condition where the heart is unable to pump enough blood and oxygen to meet the body’s needs. The heart continues to function, but its pumping ability is reduced. This can result from various causes such as heart attacks, genetic conditions, or abnormal heart valves.
Dr. Deyanira Prastein, a cardiothoracic surgeon with St. Joseph’s/Candler, explained that heart failure is common and becomes more prevalent with age. “The leading cause of death in the United States is heart disease, and the majority of people who die of heart disease have heart failure,” Dr. Prastein said.
Risk factors for developing heart failure include high blood pressure, diabetes, obesity, previous heart attacks, valve disease, coronary artery disease, congenital defects, and substance abuse involving nicotine or alcohol.
Dr. Prastein emphasized that while most cases of heart failure are not curable, they are treatable. The American Heart Association has identified four stages of heart failure:
A – Individuals have risk factors like high blood pressure or diabetes.
B – There is evidence of structural damage without symptoms.
C – Damage exists along with symptoms such as shortness of breath or fatigue.
D – Disease is severe enough to limit daily activities.
“You can have heart failure and be completely functional. That’s why the American Heart Association came up with these stages so that we can identify people who are at risk to prevent them from getting to the severe stages,” Dr. Prastein said.
For those in stage A or B, lifestyle changes—such as healthy eating, regular exercise, avoiding smoking and excessive alcohol use, and getting enough sleep—can reduce the risk of progressing to more advanced stages.
“Unless your heart failure was the result of infection or pregnancy, for most patients it’s a condition you live with,” Dr. Prastein said. “The emphasis now is that once you develop it, it is progressive, so the goal is to keep it from getting to the advanced C and D stages.”
Patients diagnosed at stage C or D are evaluated based on their symptoms’ severity and how much their daily activities are affected. “When you get symptomatic, when you are stage C, we need to classify how functional you are… because that guides treatment,” Dr. Prastein said. “We have lots of treatment options depending on your level of function.”
Treatment may involve medication if an underlying condition is present. For severe cases caused by valve problems or other structural issues unresponsive to medication, surgical intervention may be necessary.
“They get to me when they have something they need to repair or fix… such as a bypass due to a blockage or repairing a valve,” Dr. Prastein said.
Device-based therapies also exist for certain patients whose hearts remain weak despite other treatments:
– Cardiac-resynchronization therapy uses electrodes similar to a pacemaker to help synchronize heartbeat.
– Neuromodulators stimulate nerves involved in regulating the work of the heart.
Preventive care remains important for reducing risk and managing progression: “It’s doing the things we’ve known for decades—proper diet, exercise, not smoking… Heart failure is a diagnosis that makes people very anxious and nervous. It can severely impact your life but it’s so preventable and so treatable,” Dr. Prastein said.
She recommends annual visits with primary care providers for early identification and management of risk factors associated with heart failure: “We all want to see our kids grow up… In addition to longevity… how you live those years is also very important,” she added.
Dr. Deyanira Prastein received her medical degree from Virginia Commonwealth University Medical College of Virginia School of Medicine in Richmond; completed her general surgery residency at University of Maryland School of Medicine; trained in cardiothoracic surgery at Wake Forest School of Medicine; pursued advanced training in surgical therapies for advanced heart failure at Royal Papworth Hospital in Cambridge (UK) and Duke University Medical Center; holds board certification in cardiothoracic surgery; belongs to the Society of Thoracic Surgeons; specializes in procedures including CABG (coronary artery bypass grafting), minimally invasive valve surgery, TAVR (transcatheter aortic valve replacement), and repairs for aortic aneurysms; speaks English and Spanish fluently.
St. Joseph’s/Candler provides healthcare services across more than 30 counties in southeast Georgia and South Carolina Lowcountry through facilities such as St. Joseph’s Hospital and Candler Hospital (official website). The health system offers specialized care including cancer treatment, cardiac services—including those discussed by Dr. Prastein—women’s health services, neurosciences care, and advanced surgical procedures (official website). Recognized for nursing excellence through Magnet status (official website), St. Joseph’s/Candler supports community health through outreach programs addressing local needs (official website) while providing compassionate healthcare guided by faith (official website).
