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Therapies for Advanced Heart Failure Patients Ineligible for Heart Transplantation: Beyond Pharmacotherapy
Ashlay A Huitema1, Karen Harkness2, Shiraz Malik3
1St Joseph's Health Care London, London, Ontario, Canada; Western University, London, Ontario, Canada.
The Canadian Journal of Cardiology
|February 11, 2020
Summary
For advanced heart failure (HF) patients ineligible for heart transplantation, palliative care, cardiac rehabilitation, device therapy, and mechanical circulatory support offer significant benefits. These interventions improve quality of life, reduce hospitalizations, and enhance survival rates.
Area of Science:
- Cardiology
- Geriatrics
- Palliative Care
Background:
- Heart failure (HF) affects millions globally, with a growing elderly population experiencing advanced stages.
- Despite advances, many HF patients require advanced therapies but are ineligible for orthotopic heart transplantation.
- This necessitates exploring alternative treatments to improve outcomes for transplant-ineligible advanced HF patients.
Purpose of the Study:
- To review the benefits of palliative care (PC), exercise-based cardiac rehabilitation (ExCR), device therapy, and mechanical circulatory support (MCS) in advanced HF patients.
- To highlight treatment options for improving quality of life, reducing hospitalizations, and potentially improving survival in this patient group.
Main Methods:
- Review of palliative care interventions for symptom management and goals of care.
- Analysis of exercise-based cardiac rehabilitation for improving quality of life and functional capacity.
- Evaluation of device therapy (cardiac resynchronization therapy, mitral clip) and MCS for reducing HF hospitalizations and improving survival.
Main Results:
- Palliative care, introduced early, manages symptoms and improves patient-centered outcomes.
- Exercise-based cardiac rehabilitation safely enhances health-related quality of life and functional capacity.
- Device therapy and MCS reduce HF hospitalizations, with MCS survival approaching that of heart transplantation.
Conclusions:
- Transplant-ineligible advanced HF patients have multiple viable treatment options.
- These therapies, including PC, ExCR, device therapy, and MCS, can significantly improve patient quality of life, decrease hospitalizations, and potentially prolong survival.
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