What is heart failure?
Heart failure means the heart is not pumping or filling as well as it should to meet the body’s needs. It does not mean the heart has stopped. It is a long-term condition that usually gets worse over time without treatment, but modern treatment can greatly improve symptoms and survival. The NHS heart failure guide provides a full overview.
Types
- Heart failure with reduced ejection fraction (HFrEF): the heart muscle pumps weakly (ejection fraction usually 40% or less)
- Heart failure with mildly reduced ejection fraction (HFmrEF): 41–49%
- Heart failure with preserved ejection fraction (HFpEF): the heart is stiff and fills poorly (50% or more)
Symptoms
- Breathlessness on activity, lying flat or at night
- Tiredness and reduced exercise tolerance
- Swollen ankles, legs or abdomen
- Rapid weight gain from fluid
- Persistent cough or wheeze
- Palpitations, dizziness
Seek emergency care for chest pain, severe breathlessness at rest, fainting, or coughing up pink frothy sputum.
Causes
- Coronary artery disease and previous heart attack (the most common cause of HFrEF)
- High blood pressure
- Cardiomyopathies (genetic, viral, alcohol- or chemotherapy-related)
- Heart valve disease
- Atrial fibrillation and other rhythm problems
- Diabetes, obesity, kidney disease
- Thyroid disease, anaemia
Diagnosis
| Test | Purpose |
|---|---|
| Echocardiogram | Measures ejection fraction, valve function, wall motion |
| NT-proBNP / BNP blood test | Supports diagnosis and tracks severity |
| ECG | Rhythm problems, previous heart attack |
| Chest X-ray | Fluid on the lungs, heart size |
| Cardiac MRI | Scar tissue, cause of cardiomyopathy |
| Coronary angiography | Blocked arteries |
| NYHA class (I–IV) | Grades symptom severity |
Your echocardiogram and cardiologist letters are essential before any treatment discussion. You can send your reports for a doctor review.
Proven treatment first
Heart failure treatment has improved dramatically. For HFrEF, guidelines from the European Society of Cardiology and the American Heart Association recommend four core medicine groups:
- ARNI (sacubitril/valsartan), or ACE inhibitor / ARB
- Beta-blockers (bisoprolol, carvedilol, metoprolol succinate)
- Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
- SGLT2 inhibitors (dapagliflozin, empagliflozin)
Plus, depending on the case:
- Diuretics for fluid
- Devices: implantable defibrillators (ICD), cardiac resynchronisation therapy (CRT)
- Revascularisation (stents or bypass) where appropriate
- Valve procedures such as TAVI or mitral repair
- Cardiac rehabilitation, salt and fluid advice, weight monitoring
- Advanced therapies: left ventricular assist devices and heart transplant for end-stage disease
These treatments reduce deaths and hospital admissions. Any regenerative idea is, at best, an addition after these are optimised.
Stem cell therapy for the heart: what research shows
Cell therapy for heart failure has been studied for more than 20 years. The early idea that injected cells become new heart muscle has not held up; current thinking is that any effect comes from signals that reduce inflammation and scarring. Some influential early research in this field was later retracted, which is a reminder to treat strong claims carefully.
| Trial | Cells / route | Result |
|---|---|---|
| DREAM-HF (Perin et al., JACC, 2023) | Allogeneic mesenchymal precursor cells injected into heart muscle; 565 patients with HFrEF | Did not reduce recurrent heart failure hospital events (primary endpoint) |
| CHART-1 (Bartunek et al., European Heart Journal, 2017) | Cardiopoietic bone marrow cells | Did not meet primary endpoint |
| CONCERT-HF (Bolli et al., European Journal of Heart Failure, 2021) | Bone marrow MSCs and c-kit cells | Phase 2; some signals on clinical events, no improvement in heart structure measures |
| BAMI (Mathur et al., European Heart Journal, 2020) | Bone marrow cells after heart attack | No significant effect on mortality; trial under-recruited |
Overall, the evidence level for stem cell therapy in heart failure is experimental. Meta-analyses show modest changes in ejection fraction in some smaller studies, but no proven reduction in deaths or hospital admissions.
Regulatory status
No cell therapy is approved for heart failure by the US FDA, the UK MHRA or Australia’s TGA. The FDA warns about unapproved stem cell therapies. Patients in the US, UK and Australia can search ClinicalTrials.gov for regulated trials.
Who may be a candidate, and who should not
Because heart failure is serious, our medical team applies strict criteria. Every case requires cardiology review.
May be considered for review:
- Stable chronic heart failure (no hospital admission in recent months)
- On optimised guideline-directed medicines and devices as recommended by a cardiologist
- NYHA class I–III, able to travel safely
- Cardiologist aware of and not opposed to the plan
- Full understanding that the treatment is experimental
Should not:
- Recent hospital admission, worsening symptoms or new chest pain
- Symptoms at rest (NYHA class IV) or need for IV medicines
- Uncontrolled arrhythmias, recent ICD shocks
- Severe valve disease awaiting intervention
- Recent heart attack or stroke
- Active infection, active cancer, pregnancy
- Anyone planning to stop heart medicines
Risks
- Infusion reactions: fever, chills
- Heart rhythm disturbances
- Fluid overload from IV fluids, which can worsen heart failure
- Blood clots, infection
- With direct heart injections: perforation, heart attack and stroke risk (procedural)
- Travel risks: fluid and salt changes, heat, long flights
Cells are prepared in ISO 9001:2015-certified partner laboratories.
What a Bangkok program looks like
- Send your records. Echocardiogram, NT-proBNP, ECG, cardiologist letters, medication list.
- Cardiology-informed doctor review. Often the honest advice is to optimise standard treatment first.
- Assessment in Bangkok. Examination, ECG, echocardiogram and blood tests.
- Program, if suitable, with careful fluid management, plus lifestyle and cardiovascular risk support through our longevity program.
- Full report for your cardiologist.
See how it works. Related: type 2 diabetes and stroke recovery.
Aftercare
- Continue every heart medicine exactly as prescribed
- Weigh yourself daily; report a rise of 2 kg in 3 days or increasing swelling
- Follow salt and fluid advice, especially in hot weather
- Rest after treatment; resume gentle activity gradually
- Seek urgent help for chest pain, severe breathlessness or fainting
- Arrange follow-up echocardiography with your cardiologist
Sources
- NHS: Heart failure
- Perin EC, et al. Randomized trial of targeted transendocardial mesenchymal precursor cell therapy in patients with heart failure (DREAM-HF). Journal of the American College of Cardiology, 2023.
- Bartunek J, et al. Cardiopoietic cell therapy for advanced ischaemic heart failure (CHART-1). European Heart Journal, 2017.
- Bolli R, et al. A phase II study of autologous mesenchymal stromal cells and c-kit positive cardiac cells (CONCERT-HF). European Journal of Heart Failure, 2021.
- Mathur A, et al. The effect of intracoronary infusion of bone marrow-derived mononuclear cells on all-cause mortality in acute myocardial infarction (BAMI). European Heart Journal, 2020.
- U.S. FDA: Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes
Frequently asked questions
Can stem cells repair a damaged heart?
Not in a proven way. Early hopes that stem cells would become new heart muscle have not been supported. Some trials show small changes in heart function measures, but large trials have not shown fewer hospital admissions or deaths.
What did the DREAM-HF trial show?
DREAM-HF (Perin et al., Journal of the American College of Cardiology, 2023) injected mesenchymal precursor cells into the heart muscle of 565 people with heart failure. It did not reduce the main outcome of recurrent heart failure hospital events. Exploratory findings on heart attack and stroke need confirmation.
Should I stop my heart medicines for stem cell therapy?
Absolutely not. Heart failure medicines such as ARNI or ACE inhibitors, beta-blockers, MRAs and SGLT2 inhibitors reduce the risk of death and hospital admission. Never stop or change them without your cardiologist.
Is stem cell therapy for heart failure approved anywhere?
No stem cell therapy is approved for heart failure by the US FDA, the UK MHRA or Australia's TGA. Cell therapies for the heart are available through clinical trials or, in some countries, under local rules for licensed doctors.
Is it safe to fly with heart failure?
Many people with stable heart failure can fly, but those with recent hospital admission, severe symptoms at rest or unstable rhythms should not. Ask your cardiologist for a fitness-to-fly opinion.
How do I know if I am a candidate for any program?
Send your echocardiogram report, ejection fraction, cardiologist letters and medication list on WhatsApp. A doctor will review them, and in many cases will advise optimising standard treatment first.
This page is general information, not medical advice, and does not replace a consultation with your own doctor. Results vary and no treatment outcome can be guaranteed. We are a patient coordination service and may receive a referral fee from partner medical providers. See our medical disclaimer and referral disclosure.