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.

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....

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 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.

Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations

2020 ◽  
Vol 22 (4) ◽  
pp. 183-191
Author(s):  
O. T. Kotsoeva ◽  
A. V. Koltsov ◽  
V. V. Tyrenko ◽  
A. A. Ialovets
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Surgical Methods ◽  
The Moment

This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.

scholarly journals SUPPORTING DEVICES IN THE TREATMENT OF CHRONIC HEART FAILURE IN ELDERLY AND OLD PATIENTS

2020 ◽  
Vol 2 (3) ◽  
pp. 40-57
Author(s):  
Gennadiy Hubulava ◽  
Kirill L. Kozlov ◽  
Andrey N. Bogomolov ◽  
Aleksey Volkov ◽  
Viktor N. Fedorets ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Clinical Practice ◽  
Chronic Heart Failure ◽  
Severe Heart Failure ◽  
Circulatory Support ◽  
Old Patients ◽  
Western Countries ◽  
Surgical Methods

Chronic heart failure (CHF) is a widespread disease associated with high rates of disability and mortality, as well as a decrease in the quality of life. Moreover, the vast majority of patients are elderly and senile. Modern surgical methods of treating heart failure are able to increase the duration and quality of life of such patients, however, the need far exceeds the volume of this care, and some highly effective methods common in Western countries are still not used in Russian clinical practice. Elderly age is a risk factor for the development of senile asthenia (frailty) and concomitant pathology. Large abdominal surgery is often contraindicated for patients with signs of senile asthenia, and the method of choice in patients with severe heart failure is the implantation of devices for long-term mechanical circulatory support (LT-MCS). After implantation of LT-MCS, a regression of signs of senile asthenia may be observed. The topic of an integrated approach to non-drug treatment of heart failure in elderly and senile patients in Russia has not been studied enough. In particular, the implantation of LT-MCS is not used in Russian clinical practice, while in many Western countries for many years it has been the main and most effective treatment for severe heart failure. Systematization of the available up-to-date information on this topic could help increase the duration and quality of life of patients with severe heart failure.

Quality of life in chronic disease: a comparison between patients with heart failure and patients with aphasia after stroke

2010 ◽  
Vol 19 (13-14) ◽  
pp. 1855-1860 ◽  
Author(s):  
Åsa Franzén-Dahlin ◽  
Monica Rydell Karlsson ◽  
Märit Mejhert ◽  
Ann-Charlotte Laska
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Disease ◽  
Patients With Heart Failure

Virtual reality for pain management in advanced heart failure: A randomized controlled study

2021 ◽  
pp. 026921632110412
Author(s):  
Hunter Groninger ◽  
Diana Stewart ◽  
Julia M Fisher ◽  
Eshetu Tefera ◽  
James Cowgill ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Virtual Reality ◽  
Pain Management ◽  
Guided Imagery ◽  
Advanced Heart Failure ◽  
Controlled Study ◽  
Randomized Controlled ◽  
General Distress

Background: Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population. Aim: To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control. Design: Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention. Setting/participants: Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center. Results: Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post −2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post −1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery ( p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again. Conclusion: Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure. Trial Registration: ClinicalTrials.gov database (NCT04572425).

scholarly journals Sex Differences in Quality of Life and Clinical Outcomes in Patients With Advanced Heart Failure

2020 ◽  
Vol 13 (4) ◽  
Author(s):  
Lauren K. Truby ◽  
Christopher O’Connor ◽  
Mona Fiuzat ◽  
Amanda Stebbins ◽  
Adrian Coles ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Sex Differences ◽  
Clinical Outcomes ◽  
Advanced Heart Failure
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