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Heart Failure VI: Adjunct Therapies01:22

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Adverse Event Rates Change Favorably Over Time for Patients Bridged With the HeartWare Left Ventricular Assist

Simon Maltais1, Keith D Aaronson, Jeffrey J Teuteberg

  • 1From the *Department of Cardiac Surgery, Mayo Clinic Rochester, Rochester, MN; †Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI; ‡Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; §Division of Cardiothoracic Surgery, University of Louisville, Louisville, KY; ¶MedStar Heart And Vascular Institute, MedStar Washington Hospital Center, Washington, DC; ‖Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, IL; #Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; **Heart Transplant & Ventricular Assist Device Program, Loyola University Health System, Maywood, IL; and ††HeartWare Inc., Framingham, MA.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 6, 2017
PubMed
Summary

Adverse event rates after HeartWare Ventricular Assist System (HVAD) implantation decrease significantly after the first 30 days. Rates stabilize after one year, indicating improved patient management over time.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • The HeartWare Ventricular Assist System (HVAD) improves survival and quality of life for patients with advanced heart failure.
  • Understanding the temporal patterns of adverse events (AEs) is crucial for optimizing patient care and management strategies.

Purpose of the Study:

  • To evaluate the differences in adverse event rates over time following HeartWare Ventricular Assist System (HVAD) implantation.
  • To identify specific time periods with higher or lower risks of AEs.

Main Methods:

  • A cohort of 382 patients from the ADVANCE bridge-to-transplant and continued access protocol trial were analyzed.
  • Adverse events including bleeding, cardiac arrhythmia, infection, stroke, and right heart failure were assessed at specific intervals post-HVAD implant (≤30 days, >30-180, >180-365, >365-730, >730-1,095 days).
  • Kaplan-Meier survival estimates were calculated at key time points.

Main Results:

  • Overall survival at 30 days, 6 months, 1, 2, and 3 years was 98%, 90%, 84%, 71%, and 63%, respectively.
  • Total AE rates were significantly lower in the >30-180 day period (EPPY = 5.34) and >180-365 day period (EPPY = 4.09) compared to the initial ≤30 days (EPPY = 30.36).
  • Incidence of cardiac arrhythmias, infections, strokes, and right heart failure peaked early post-implant, with lower rates after 6 months and stable, comparable rates up to 3 years.

Conclusions:

  • Adverse event rates following HVAD implantation demonstrate a significant temporal decline, particularly after the initial 30-day period.
  • AE rates stabilize after one year, suggesting a window for optimized patient management and intervention.
  • These findings have important clinical implications for improving long-term patient care and outcomes with HVAD support.