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Published on: February 13, 2021
Systolic heart failure: knowledge gaps, misconceptions, and future directions
Rohan Samson1, Rohit Ramachandran1, Thierry H Le Jemtel1
1Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
Insights
Early intervention for systolic heart failure (HF) is crucial. While beta blockers can reverse left ventricular remodeling, their preventative role and optimal patient selection for defibrillators require further study to combat this cardiovascular pandemic.
Area of Science:
- Cardiology
- Heart Failure Research
Background:
- Systolic heart failure (HF) represents a late stage of cardiovascular disease.
- Current guidelines focus on early risk factor management, but treatment often begins late (Stage C).
- HF imposes a significant burden on healthcare systems.
Purpose of the Study:
- To identify knowledge gaps and misconceptions in systolic heart failure (HF).
- To review current understanding and treatment limitations of systolic HF.
Main Methods:
- Conducted an extensive literature review.
- Utilized the MEDLINE/PubMed database for analysis.
Main Results:
- Long-term beta-adrenergic blocking is the sole pharmacologic intervention shown to reverse left ventricular remodeling.
- Uncertainty remains regarding beta blockers' ability to prevent or delay remodeling in at-risk patients.
- Knowledge gaps exist concerning patient phenotypes benefiting from implantable cardioverter defibrillator therapy.
- Acute decompensated heart failure is a misnomer; chronic HF patients deteriorate gradually before hospitalization.
- Functional class and ejection fraction show weak correlation.
- Advanced HF therapies are accessible to a very limited patient population.
Conclusions:
- Focusing on early disease stages and optimal risk factor management is critical for impacting the HF pandemic.
- Proactive management of cardiovascular risk factors is essential to mitigate the widespread impact of heart failure.
Background:
Systolic heart failure is the final manifestation of several cardiovascular conditions. The 2001 American College of Cardiology/American Heart Association guidelines depicting the progression of heart failure (HF) from stage A through stage D are aimed at the early treatment of risk factors. However, treatment is often delayed until stage C, and as a result HF continues to impose a major burden on our healthcare industry.
Methods:
We conducted an extensive literature review of the MEDLINE/PubMed database with the purpose of elucidating knowledge gaps and misconceptions regarding systolic HF.
Results:
Long-term beta adrenergic blocking is the only pharmacologic intervention that reverses left ventricular remodeling. Whether beta adrenergic blocking prevents or delays left ventricular remodeling in patients at risk of HF is presently unknown. A knowledge gap also exists regarding the phenotype of patients that derives a mortality benefit from implantable cardioverter defibrillator therapy. Acute decompensated HF is a misnomer because patients with chronic HF are known to be deteriorating in the weeks preceding hospitalization. Functional class and ejection fraction are not closely correlated. Advanced HF therapies such as heart transplantation and mechanical circulatory support are available to an extremely small fraction of patients with systolic HF.
Conclusion:
Concentrating efforts on the early stages of the disease process with optimal management of risk factors for HF is critical to having a significant impact on this ongoing pandemic.
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