Heart failure clinics
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Heart failure clinics · Jul 2015
ReviewTeam-based Palliative and End-of-life Care for Heart Failure.
Clinical practice guidelines endorse the use of palliative care in patients with symptomatic heart failure. Palliative care is conceptualized as supportive care afforded to most patients with chronic, life-limiting illness. However, the optimal content and delivery of palliative care interventions remains unknown and its integration into existing heart failure disease management continues to be a challenge. Therefore, this article comments on the current state of multidisciplinary care for such patients, explores evidence supporting a team-based approach to palliative and end-of-life care for patients with heart failure, and identifies high-priority areas for research.
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Heart failure clinics · Apr 2015
ReviewHemodynamic support with percutaneous devices in patients with heart failure.
The use of surgically implanted durable mechanical circulatory support (MCS) in high-risk patients with heart failure is declining and short-term, nondurable MCS device use is growing. Percutaneously delivered MCS options for advanced heart failure include the intra-aortic balloon pump, Impella axial flow catheter, TandemHeart centrifugal pump, and venoarterial extracorporeal membrane oxygenation. ⋯ Algorithms and guidelines for optimal nondurable MCS device selection do not exist. Emerging technologies and applications will address the need for improved left ventricular unloading using lower-profile devices, longer-term ambulatory support, and the potential for myocardial recovery.
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Heart failure clinics · Oct 2014
ReviewPotential roles of vaptans in heart failure: experience from clinical trials and considerations for optimizing therapy in target patients.
Hyponatremia is a known complication in patients with heart failure (HF). HF patients with severe congestion, hyponatremia, and renal insufficiency are difficult to manage and may have worse outcomes. ⋯ AVP antagonists have thus been developed to increase aquaresis and serum sodium levels in patients with euvolemic and hypervolemic hyponatremia. Although tolvaptan, an AVP-2 receptor antagonist, did not show outcomes benefit in patients with decompensated HF, prospective studies are ongoing to evaluate its optimal role in targeted HF patients.
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Heart failure clinics · Oct 2014
ReviewTime and technology will tell: the pathophysiologic basis of neurohormonal modulation in heart failure.
The central roles of neurohormonal abnormalities in the pathobiology of heart failure have been defined in recent decades. Experiments have revealed both systemic involvement and intricate subcellular regulation by circulating effectors of the sympathetic nervous system, the renin-angiotensin-aldosterone system, and others. Randomized clinical trials substantiated these findings, establishing neurohormonal antagonists as cornerstones of heart failure pharmacotherapy, and occasionally offering further insight on mode of benefit. This review discusses the use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists in the treatment of heart failure, with particular attention to the pathophysiologic basis and mechanisms of action.
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Heart failure clinics · Jan 2014
Review Historical ArticleA history of devices as an alternative to heart transplantation.
The rapid evolution of mechanical circulatory support (MCS) has extended survival and improved quality of life for patients suffering from the most advanced heart failure (HF). Survival at one year after placement of a left ventricular assist device exceeds 80%. ⋯ Patients with HF now have a meaningful option for lifelong support even if they are not candidates for heart transplant. As the profiles of MCS recipients change and the next generation of devices emerges, new challenges and opportunities await physicians caring for patients with cardiac failure.