Rapid Clinical Updates: Advanced Therapy for End-Stage Heart Failure-Slides

Slides

Pdf Summary

This comprehensive presentation provides rapid clinical updates on advanced therapy for end-stage heart failure (HF), delivered by experts from UCLA, Baystate Health, and Thomas Jefferson University. It outlines the diagnosis, staging, management, and cutting-edge treatments for advanced HF, emphasizing interdisciplinary and patient-centered approaches.<br /><br />Key points include HF classification by left ventricular ejection fraction (LVEF) into HFrEF, HFmrEF, and HFpEF, with corresponding guideline-directed medical therapies (GDMT). The importance of early and ongoing assessment using clinical history, biomarkers like NT-proBNP, imaging, and patient-reported outcomes is stressed for optimal management and prognosis evaluation.<br /><br />Advanced HF patients often exhibit severe symptoms (NYHA class III-IV), frequent hospitalizations, and end-organ dysfunction, necessitating timely referral to specialty centers. The "I-NEED-HELP" mnemonic aids clinicians in identifying candidates for advanced therapies including mechanical circulatory support (MCS), left ventricular assist devices (LVADs), cardiac transplantation, and palliative care.<br /><br />GDMT remains foundational in HF care, with high-value medications including ACE inhibitors, ARNi, beta-blockers, MRAs, and SGLT2 inhibitors. Device therapies like implantable cardioverter-defibrillators and cardiac resynchronization therapy are also economically valuable. Additional treatments such as ivabradine and vericiguat may be considered after GDMT optimization.<br /><br />Advanced therapies such as LVAD implantation and cardiac transplantation improve survival and quality of life but require careful patient selection balancing comorbidities, functional status, and psychosocial factors. Temporary MCS like Impella and VA ECMO serve as bridges to recovery or decision.<br /><br />A major theme is the integration of palliative care early in the HF trajectory to address symptom burden, psychological distress, and quality of life, supported by evidence from trials like PAL-HF. Despite clear benefits, palliative care remains underutilized in advanced HF management.<br /><br />Challenges including prognostic uncertainty, healthcare system barriers, and disparities call for evolving care models emphasizing shared decision-making, multidisciplinary collaboration, and holistic patient-centered strategies. The presentation underscores the importance of combining medical innovation with compassionate care to enhance both longevity and life quality for patients facing end-stage heart failure.

Keywords

advanced heart failure

left ventricular ejection fraction

guideline-directed medical therapy

mechanical circulatory support

left ventricular assist device

cardiac transplantation

palliative care

implantable cardioverter-defibrillator

cardiac resynchronization therapy

shared decision-making