Heart Failure Devices: Treatment Options, Underutilization, and a Proposed Trigger System for Patient Referral and...

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Guideline-directed medical therapy (GDMT) has significantly improved outcomes for heart failure (HF) patients.
• Suboptimal adherence and residual risk of hospitalization and death persist despite maximized GDMT.

Purpose of the Study:

• To review US Food and Drug Administration-approved device therapies for HF that reduce morbidity and/or mortality.
• To discuss pivotal trials, patient populations, and current low clinical adoption rates of these devices.
• To propose a mnemonic to improve identification and referral of HF patients for device therapy consideration.

Main Methods:

• Review of pivotal trials for FDA-approved device interventions in heart failure.
• Analysis of current clinical practice patterns and barriers to device therapy uptake.
• Development of a mnemonic to aid clinician decision-making.

Main Results:

• Several device options, including valvular interventions, cardiac resynchronization, and others, are available for HF patients.
• Clinical utilization of these devices remains significantly low, with many eligible patients not receiving them.
• Lack of clinical awareness regarding escalation of therapy and patient identification are key barriers.

Conclusions:

• Device therapies represent crucial options for reducing residual risk in heart failure patients on GDMT.
• Addressing awareness gaps and improving referral pathways are essential for increasing appropriate device therapy use.
• A proposed mnemonic aims to facilitate early identification and referral for device-based interventions.