Songfacts®:

• This song has nothing to do with the city of Cleveland, Ohio. A "Cleveland Heart" is an artificial heart made and installed by the Cleveland Heart Institute, a renowned medical center. In the song, Browne wants a new heart because his old one keeps making the same mistakes over and over. If he can get a dispassionate mechanical device in his chest, he'll be able to move forward more rationally (this is all purely metaphorical, Browne's actual heart is just fine).
• Browne got the idea for this song when he was driving in Cleveland with a friend, who pointed out the Cleveland Heart Institute and explained that they make artificial hearts. "Yeah, I need one of those," Browne thought.
• I'm going to make a few changes right away
  The way I leap and the way I fall
  The way I need somebody else's eyes to see me
  The way I need anyone at all
  
  "We do need other people's eyes to see us," he said in a public broadcasting interview. "That's what's comical about the song: it's defiant. 'I don't need anybody.' It's like a Swiftian modest proposal: I'm just going to replace my heart with something that works because this one I've got has had it."
• The music video was directed by Alissa Torvinen Kouame. It shows Browne going under the knife for an artificial heart, with his band members playing the medical team. Phoebe Bridgers also shows up, playing a nurse who gets stuck holding his heart, which she starts eating. Browne and Bridgers have teamed up before: He sang on her track "Christmas Song" in 2018, and also on a version of her song "Kyoto" earlier in 2021.
• Browne wrote this song with his guitarist, Val McCallum. They had the music done long before the lyrics. It was the first song they completed for the Downhill From Everywhere album.