Related Experiment Video
Updated: Dec 29, 2025
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
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.
Insights
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.
Abstract:
Globally, there are ∼ 26 million people living with heart failure (HF), 50% of them with reduced ejection fraction, costing countries billions of dollars each year. Improvements in treatment of cardiovascular diseases, including advanced HF, have allowed an unprecedented number of patients to survive into old age. Despite these advances, patients with HF deteriorate and often require advanced therapies. As the proportion of elderly patients in the population increases, there will be an increasing number of patients to be evaluated for advanced therapies and an increasing number that do not qualify for, won't be considered for, or decline orthotopic heart transplantation. The purpose of this article is to review the benefits of palliative care (PC), exercise-based cardiac rehabilitation (ExCR), device therapy (cardiac resynchronization therapy and mitral clip), and mechanical circulatory support (MCS) in advanced HF patients who are transplant ineligible. PC interventions should be introduced early in the course of a patient's diagnosis to manage symptoms, address goals of care, and improve patient-centered outcomes. Further improvement in health-related quality of life as well as functional capacity can be achieved safely in patients with advanced HF through patient participation in ExCR. Device therapy and MCS can reduce HF hospitalizations and improve survival. In fact, early survival with MCS approaches that of heart transplantation. Despite their being transplant ineligible, there are a variety of treatment options available to patients to improve their quality of life, decrease hospitalizations, and potentially improve mortality.
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
01:30Heart Failure V: Medical Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:26Heart Failure Drugs: Inotropic Agents