Advanced Heart Failure Management and Selection for Advanced Therapies

Advanced Heart Failure Management and Selection for Advanced Therapies

Alexander Papolos (Icahn School of Medicine at Mount Sinai, USA), Nishant A. Gandhi (Icahn School of Medicine at Mount Sinai, USA), Elrond Teo (Emory University Hospital, USA) and Raymond Bietry (Icahn School of Medicine at Mount Sinai, USA)
Copyright: © 2015 |Pages: 20
DOI: 10.4018/978-1-4666-8603-8.ch009
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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.
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Heart failure is a multifaceted clinical syndrome of impaired cardiac function in which the heart fails to meet the metabolic demands of the body. Today an estimated 5 million Americans are living with heart failure, and current projections estimate this will increase 25% by 2030 (Go et al., 2013). In 2011, heart failure was the second most common reason for hospitalization among Americans aged 65-85 (Pfuntner, Wier, & Stockes, 2013). Not only is heart failure a menace to public health, but in 2013 the economic burden associated with its treatment was approximated to be $32 billion (Go et al., 2013).

Large randomized controlled trials have provided a robust armament of pharmacological and electrophysiological therapies to improve both mortality and quality of life. Unfortunately, events such as life threatening arrhythmias, clinical decompensation, and progressive end-organ damage remain common among patients with heart failure. Thus, early consideration of mechanical circulatory support and cardiac transplant must be made in patients at increased risk of morbidity and mortality despite adequate medical therapy.


  • 1.

    Understand guideline directed therapy for heart failure.

  • 2.

    Identify the patient refractory to medical therapy.

  • 3.

    Understand the role of pre-surgical optimization prior to surgery for advanced therapies.

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