Advanced Heart Failure Management and Selection for Advanced Therapies

Introduction

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.