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Mechanical circulatory support for elderly heart failure patients.
Craig R Butler1, Bodh I Jugdutt
1Division of Cardiology, Walter C. Mackenzie Health Sciences Center, University of Alberta, 8440-112 Street, Edmonton, AB, Canada. crbutler@ualberta.ca
Heart Failure Reviews
|January 13, 2012
Summary
Mechanical circulatory support (MCS) offers improved survival for elderly patients with systolic heart failure. Continuous flow devices show particular benefit, but pre-implantation assessment and cost-benefit analysis are crucial for destination therapy.
Area of Science:
- Cardiology
- Geriatrics
- Biomedical Engineering
Background:
- End-stage systolic heart failure is prevalent in elderly patients, leading to poor quality of life and outcomes.
- Mechanical circulatory support (MCS) is a viable option for heart transplantation and destination therapy.
- Older patients often face ineligibility for heart transplantation due to age and comorbidities, leaving MCS for destination therapy less defined.
Purpose of the Study:
- To review the literature on MCS in older heart failure populations.
- To characterize the current experience with MCS as destination therapy in elderly patients.
- To identify key considerations for implementing MCS in this demographic.
Main Methods:
- A comprehensive literature review was conducted.
- Data on the use and outcomes of MCS in elderly heart failure patients were analyzed.
- Focus was placed on continuous flow (CF) devices.
Main Results:
- MCS is increasingly utilized for destination therapy in older adults with heart failure.
- Continuous flow (CF) devices demonstrate significant advantages in elderly patients.
- A marked improvement in 1- and 2-year survival rates was observed with CF devices.
Conclusions:
- Rational implementation of MCS in elderly heart failure patients should prioritize CF devices.
- Extensive pre-MCS assessment, including frailty evaluation, is essential.
- Intervention prior to cardiogenic shock and further cost-benefit analysis are needed for routine CF device use as destination therapy.
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