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Published on: December 2, 2016
Treatment of heart failure beyond practice guidelines. Role of cardiac remodeling
Arunima Misra1, Douglas L Mann
1Winters Center for Heart Failure Research, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Insights
Despite guideline-adherent treatments, heart failure (HF) mortality remains high. Novel device strategies targeting cardiac remodeling are needed to improve outcomes for symptomatic HF patients.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Heart failure (HF) is a syndrome driven by deleterious molecular overactivity.
- Current guideline-based treatments (ACE inhibitors/ARBs, beta-blockers) improve survival but not enough.
- High mortality persists in symptomatic HF patients, indicating an unmet therapeutic need.
Purpose of the Study:
- To review cardiac remodeling as a key HF progression mechanism.
- To discuss novel device-based treatment strategies for HF.
- To address the need for improved therapies preventing cardiac remodeling.
Main Methods:
- Literature review on HF pathophysiology and treatment.
- Analysis of cardiac remodeling mechanisms in heart failure.
- Exploration of emerging device therapies for HF management.
Main Results:
- Cardiac remodeling is a significant driver of HF progression.
- Existing therapies inadequately address remodeling.
- Novel device strategies show promise in preventing remodeling.
Conclusions:
- Despite advances, HF treatment requires further innovation.
- Targeting cardiac remodeling with novel devices offers a potential therapeutic avenue.
- Addressing the unmet need in HF management is critical for improving patient outcomes.
Abstract:
Heart failure (HF) is clinical syndrome that develops and progresses as a result of the overexpression of biologically active molecules that are sufficient to cause deleterious effects on the heart and circulation. Over the past 2 decades the adherence to practice guidelines for treating HF, including the use of angiotensin-converting enzyme inhibitors/angiotensin-receptor antagonists and beta-blockers, has resulted in improved survival for patients. However, despite the use of these evidence-based strategies that block the deleterious effects of neurohormonal activation, the overall mortality for HF remains unacceptably high. Unfortunately, when patients remain symptomatic despite having their medical and/or device therapies optimized, the "next steps" to improving patient morbidity are not at all clear. Thus, there remains an unmet need with respect to the treatment of HF patients. The concept that cardiac remodeling represents an important mechanism for disease progression in HF is reviewed, as well as discussion of several novel treatment strategies with respect to devices that are intended to prevent worsening cardiac remodeling.
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