Therapies for advanced heart failure patients ineligible for heart transplant; beyond pharmacotherapy

Publication date: Available online 20 November 2019Source: Canadian Journal of CardiologyAuthor(s): Ashlay A. Huitema, Karen Harkness, Shiraz Malik, Neville Suskin, Robert S. McKelvieABSTRACTGlobally, there are approximately 26 million people living with heart failure (HF) and 50% of those patients suffer from HF with reduced ejection fraction (HFrEF), costing countries billions of dollars each year. Improvements in treatment of cardiovascular diseases, including advanced HF, have allowed an unprecedented number of patients to survive into old age. Despite these advances, patients with HF deteriorate and often require advanced therapies. As the proportion of elderly patients in the population increases, there will be an increasing number of patients to be evaluated for advanced therapies and an increasing number that do not qualify, won’t be considered for or decline orthotopic heart transplant (OHT). The purpose of this article is to review the benefits of palliative care (PC), exercise-based cardiac rehabilitation (ExCR), device therapy (cardiac resynchronization therapy and mitralclip) and mechanical circulatory support (MCS) in advanced HF patients who are transplant ineligible. PC interventions should be introduced early in the course of a patient’s diagnosis to manage symptoms, address goals of care and improve patient-centered outcomes. Further improvement in health-related quality of life as well as functional capacity can be achieved safely in patients with advan...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research