Optimizing heart failure treatment following cardiac resynchronization therapy
Anders Jorsal1, Kasper Pryds2,3,4, John J V McMurray5,6
1Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Summary
Many heart failure patients remain symptomatic after cardiac resynchronization therapy (CRT). A significant portion could benefit from optimizing medical therapy with sacubitril/valsartan or ivabradine.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes for select heart failure patients.
- Persistent symptoms or disease progression can occur despite CRT.
- Optimizing medical therapy may further benefit patients post-CRT.
Purpose of the Study:
- To determine the proportion of patients eligible for sacubitril/valsartan and/or ivabradine after CRT.
- To assess the need for medical therapy optimization in symptomatic patients post-CRT.
Main Methods:
- Post hoc analysis of a randomized controlled trial.
- Evaluated 182 patients undergoing CRT.
- Assessed eligibility for sacubitril/valsartan and/or ivabradine at baseline and 6 months post-CRT.
Main Results:
- 80% of patients had an indication for medical therapy optimization at baseline.
- At 6 months, 38% of symptomatic survivors were eligible for sacubitril/valsartan, ivabradine, or both.
- 18% of patients initially without indication developed one by 6 months.
Conclusions:
- A substantial proportion of symptomatic patients post-CRT are candidates for enhanced medical therapy.
- Systematic follow-up and medical treatment evaluation are crucial for CRT patients.
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
263
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.
263
01:30Heart Failure V: Medical Management
223
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...
223
01:29Cardiomyopathy V: Interprofessional Care
343
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...
343
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
943
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
943
01:30Cardiomyopathy II: Dilated Cardiomyopathy
480
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
480
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
416
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
416