Advanced heart failure with reduced ejection fraction
Patients suffering advanced heart failure with reduced ejection fraction (HFrEF) account for a large portion of patients admitted to hospitals worldwide. Mortality and 30-day readmission rates for HFrEF are now a focus of value-based payment models, making management of this disease a priority for hospitals, physicians, and payers alike. Angiotensin-converting enzyme inhibitors have been the cornerstone of therapy for decades. However, with treatment, the prognosis for patients with advanced HFrEF remains poor. Fortunately, advances in medical therapy and mechanical support offer some patients improvement in both survival and quality of life. We review advances in short- and long-term mechanical support and explore changes to organ allocation for cardiac transplantation. In addition, we provide a guide to facilitate appropriate referral to an advanced heart failure team.
Dr. Hicks is interim medical director of advanced heart failure, mechanical circulatory support, and cardiac transplant at Baylor Scott & White in Temple, Texas, and the assistant program director for the cardiology fellowship. Dr. Velazco is director of the cardiothoracic intensive care unit at Baylor Scott & White Medical Center – Temple. Dr. Gohar is medical director of the advanced heart failure and mechanical circulatory support service, Baylor All Saints Medical Center, Fort Worth, Texas. Dr. Seliem is a board-certified interventional cardiologist completing a heart failure fellowship at Baylor University Medical Center at Dallas. Dr. Hall is chief of transplant cardiology, mechanical circulatory support, and advanced heart failure at Baylor University Medical Center at Dallas. Dr. Michel is chief of the division of cardiology at Baylor Scott & White Memorial Hospital, Temple, Texas. Dr. Hall disclosed relationships with Novartis (honorarium/speaker) and CareDx, Abbott, and Abiomed (honorarium/consultant), and Dr. Seliem disclosed a relationship with Abbott (honorarium/speaker). The other authors, reviewers, and editor have no conflicts of interest to disclose.
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After completing the article, the learner should be able to
- Recognize the poor prognosis of patients with advanced heart failure
- Distinguish between the different types of mechanical support used to treat patients
- Select patients who would benefit from referral to advanced heart failure cardiologists
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