scholarly journals Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Keith M. Swetz ◽  
John M. Stulak ◽  
Shannon M. Dunlay ◽  
Ellin F. Gafford
Keyword(s):  
Heart Failure ◽  
Ethical Issues ◽  
The Elderly ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Future Directions ◽  
Goods And Services ◽  
Mechanical Circulatory Support Devices ◽  
Made In

Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

scholarly journals Updates on management of advanced heart failure

2017 ◽  
Vol 5 (20) ◽  
pp. 12
Author(s):  
Hatice Duygu Bas ◽  
Kazim Baser ◽  
Nandini Nair
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Patients With Heart Failure ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices ◽  
Recommended Therapy

Advanced heart failure defines a subset of patients with heart failure with reduced ejectionfraction having severe symptoms despite usual recommended therapy. These patients requirefrequent hospitalizations and specialized interventions, such as cardiac transplantation,implantation of mechanical circulatory support devices, continuous intravenous inotropictherapy to palliate symptoms, or continued terminal care. This review summarizes themanagement of advanced heart failure with updates in medical therapy and recent advancesin surgical therapy, particularly left ventricular assist device therapy.

Cardiac transplantation and mechanical circulatory support

2010 ◽  
pp. 2729-2735
Author(s):  
Jayan Parameshwar ◽  
Steven Tsui
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Cardiac Transplantation ◽  
Immunosuppressive Agents ◽  
Cardiac Allograft Vasculopathy ◽  
Advanced Heart Failure ◽  
Cardiac Allograft ◽  
Circulatory Support ◽  
Allograft Vasculopathy

Cardiac transplantation is the treatment of choice for selected patients with advanced heart failure: median survival exceeds 10 years and recipients enjoy an excellent quality of life, but availability is severely limited by shortage of donor organs. The need for lifelong immunosuppression is associated with side effects, including an increased incidence of malignancy. Newer immunosuppressive agents offer promise in reducing nephrotoxicity of conventional regimens and in delaying the onset of (currently inevitable) cardiac allograft vasculopathy....

Advanced Heart Failure Management and Selection for Advanced Therapies

2015 ◽  
pp. 216-235
Author(s):  
Alexander Papolos ◽  
Nishant A. Gandhi ◽  
Elrond Teo ◽  
Raymond Bietry
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Disease ◽  
Cardiac Transplantation ◽  
Advanced Heart Failure ◽  
Therapeutic Window ◽  
Circulatory Support ◽  
Narrow Therapeutic Window ◽  
Advanced Therapies

Advancements in the field of heart failure have significantly improved both mortality and the quality of life of millions. However, heart failure generally remains a chronic disease with an insidious progression to organ failure despite optimal medical treatment. Early consideration of advanced therapies such as mechanical circulatory support and cardiac transplantation in advanced heart failure is essential. The purpose of this chapter is to assist the reader in the identification of patients with advanced heart failure that have not yet developed irreversible end-organ dysfunction, as interventions in this narrow therapeutic window results in improved post-surgical outcomes.

scholarly journals Advanced Heart Failure and End-Stage Heart Failure: Does a Difference Exist

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 170 ◽  
Author(s):  
Severino ◽  
Mather ◽  
Pucci ◽  
D’Amato ◽  
Mariani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Clinical Symptoms ◽  
Advanced Heart Failure ◽  
Correct Selection ◽  
Circulatory Support ◽  
Advanced Therapy ◽  
The Right ◽  
End Stage

Advanced heart failure (AdHF) represents a challenging aspect of heart failure patients. Because of worsening clinical symptoms, high rates of re-hospitalization and mortality, AdHF represents an unstable condition where standard treatments are inadequate and additional interventions must be applied. A heart transplant is considered the optimal therapy for AdHF, but the great problem linked to the scarcity of organs and long waiting lists have led to the use of mechanical circulatory support with ventricular-assist device (VAD) as a destination therapy. VAD placement improves the prognosis, functional status, and quality of life of AdHF patients, with high rates of survival at 1 year, similar to transplant. However, the key element is to select the right patient at the right moment. The complete assessment must include a careful clinical evaluation, but also take into account psychosocial factors that are of crucial importance in the out-of-hospital management. It is important to distinguish between AdHF and end-stage HF, for which advanced therapy interventions would be unreasonable due to severe and irreversible organ damage and, instead, palliative care should be preferred to improve quality of life and relief of suffering. The correct selection of patients represents a great issue to solve, both ethically and economically.

scholarly journals Short-Term Therapies for Treatment of Acute and Advanced Heart Failure—Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?

2019 ◽  
Vol 8 (11) ◽  
pp. 1834 ◽  
Author(s):  
Piero Pollesello ◽  
Tuvia Ben Gal ◽  
Dominique Bettex ◽  
Vladimir Cerny ◽  
Josep Comin-Colet ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Elderly Population ◽  
The Elderly ◽  
Development Project ◽  
Advanced Heart Failure ◽  
Clinical Use ◽  
New Agents ◽  
The Moment

Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but—per definition—causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio- and vasoactive drugs used in the hospitalization phase to stabilize the patient’s hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g. catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents.

scholarly journals Outcomes with Ventricular Assist Device Therapy for Advanced Heart Failure in North Macedonia: First Annual Report

2020 ◽  
Vol 23 (4) ◽  
pp. E441-E446
Author(s):  
Petar Risteski ◽  
Tanja Anguseva ◽  
Rodney Rosalia ◽  
Sonija Grazdani ◽  
Milka Klincheva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Developing Countries ◽  
Annual Report ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
The Republic

Introduction: Mechanical circulatory support by a continuous-flow ventricular assist device (VAD) improves survival and quality of life in selected patients with advanced heart failure. Developing countries have been struggling to construct a contemporary and effective health care system to manage advanced heart failure. This observation represents the first annual report on clinical outcomes with VAD for patients with advanced heart failure in the Republic of North Macedonia. Methods: Data from all patients with VAD implantations between November 2018 and December 2019 were collected. The etiology of the heart failure was dilated cardiomyopathy in 4 patients (57%), ischemic cardiomyopathy in 2 (28%), and hypertrophic cardiomyopathy in 1 (14%). The primary outcome was survival; secondary outcomes included adverse events defined according to the Interagency Registry for Mechanically Assisted Circulatory Support. Results: A total of 7 patients (85% males, median age 56 years) received a VAD; 5 of them received left VAD, and the remaining 2 received biventricular VAD. There were no deaths. Observed morbidity during a mean follow-up of 216 days included 3 bleeding events in 1 patient, 2 patients with superficial driveline infection, and 1 minor stroke and a pump thrombosis, which were treated with VAD exchange. Significant improvement in quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire and the Functional Independence Measure™ instrument, was seen with all patients. Conclusions: Our results demonstrate a successful initiation of the VAD program in the Republic of North Macedonia. Proper training of a dedicated HF team supports the reproducibility of this treatment in developing countries.

scholarly journals Treatment and management of advanced heart failure in elderly

2019 ◽  
Vol 89 (1) ◽  
Author(s):  
Nidal Tourkmani
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Health Care Professionals ◽  
The Elderly ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
High Morbidity ◽  
Open Communication ◽  
Limiting Condition ◽  
End Stage

Heart failure (HF) is a life-limiting condition, associated with high morbidity. End-stage, known as advanced heart failure (AHF), is more common among the elderly. HF patients’ disease trajectory is more variable and unpredictable than the trajectory for most oncologic illnesses. Despite a growing armamentarium of resources the management of AHF patients can be complex. Advances in medical therapy have dramatically improved the quality of life and survival of patients with end-stage HF. The majority of studies reveal lack of knowledge of HF among elderly patients. Mechanical circulatory support can provide bridge-to-transplantation therapy in eligible patients or destination therapy in those ineligible for heart transplantation like the majority of elderly patients with HF. The palliative care stage, considered as treatment basically aimed at controlling symptoms, may last a long time in some patients and should not simply be regarded as the final phase. Studies show that patients with AHF may have a poor understanding of their condition and its outcome and, therefore, guidelines recommend health care professionals to have an open communication with patients and their families about the AHF trajectory, including discussing their preferences for future care, acknowleding the risk of a sudden death, and the possibility of deactivation of devices (i.e. implantable defibrillators) in the end-of-life. This contribution is an attempt to have a brief overview of strategies for the management of HF terminal stage in elderly.

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