Heart failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care

Publication date: Available online 26 July 2019Source: Canadian Journal of CardiologyAuthor(s): David S. Crossland, Alexander Van De Bruaene, Candice K. Silversides, Edward J. Hickey, S. Lucy RocheAbstractThere is mounting recognition that some of the most urgent problems of adult congenital heart disease (ACHD) are the prevention, diagnosis and management of heart failure (HF). Recent expert consensus and position statements emphasise a specific and pressing need to tackle HF in ACHD (ACHD-HF) but also highlight the difficulty of doing so given a current sparsity of data. Some of the challenges will be addressed by this review. The authors are from three different centres; each centre has an established sub-speciality ACHD-heart failure (ACHD-HF) clinic and is able to provide heart transplant, multi-organ transplant and mechanical support for ACHD patients. Appropriate care of this complex population requires multi-disciplinary ACHD-HF teams evaluate all possible treatment options. The risks and benefits of non-transplant ACHD surgery, percutaneous structural and electrophysiological intervention, and ongoing conservative management must be considered alongside those of transplant strategies. In our approach, advanced care planning and palliative care coexist with the consideration of advanced therapies. An ethos of shared decision-making, guided by the patient’s values and preferences, strengthens clinical care, but requires investment of time as well as skilled communica...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research