Device Therapy in Advanced Heart Failure: What to Put In and What to Turn Off

Smith, Sakima A.; Abraham, William T.

doi:10.1111/j.1751-7133.2011.00238.x

Cited by 4 publications

(3 citation statements)

References 49 publications

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“…18,28,32,97 Advanced echocardiographic measures have been explored as a possible means of identifying patients who will respond to CRT, and an important study using tissue Doppler imaging described the presence of increased LV dyssynchrony at baseline as a marker of individuals likely to respond to CRT and have a good overall prognosis. 98 The main problem with wide-scale implementation of tissue Doppler imaging and echocardiographic techniques to detect dyssynchrony is that many studies show an inability to predict a positive response, and the sensitivity and specificity of the techniques are not strong enough to justify routine clinical use.…”

Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

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Devices in the management of advanced, chronic heart failure

Abraham

Smith

2012

Nat Rev Cardiol

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Heart failure (HF) is a global phenomenon, and the overall incidence and prevalence of the condition are steadily increasing. Medical therapies have proven efficacious, but only a small number of pharmacological options are in development. When patients cease to respond adequately to optimal medical therapy, cardiac resynchronization therapy has been shown to improve symptoms, reduce hospitalizations, promote reverse remodelling, and decrease mortality. However, challenges remain in identifying the ideal recipients for this therapy. The field of mechanical circulatory support has seen immense growth since the early 2000s, and left ventricular assist devices (LVADs) have transitioned over the past decade from large, pulsatile devices to smaller, more-compact, continuous-flow devices. Infections and haematological issues are still important areas that need to be addressed. Whereas LVADs were once approved only for ‘bridge to transplantation’, these devices are now used as destination therapy for critically ill patients with HF, allowing these individuals to return to the community. A host of novel strategies, including cardiac contractility modulation, implantable haemodynamic-monitoring devices, and phrenic and vagus nerve stimulation, are under investigation and might have an impact on the future care of patients with chronic HF.

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Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

“…14–16 In addition, the 5-year age-adjusted mortality from HF is 59% and 45% for men and women, respectively. 17 Remote monitoring is a promising management strategy for ambulatory patients with HF, 18 but many individuals with chronic HF require advanced mechanical therapies just to survive. Nevertheless, causes for optimism exist.…”

Section: Introductionmentioning

confidence: 99%

Devices in the management of advanced, chronic heart failure

Abraham

Smith

2012

Nat Rev Cardiol

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“…Often over-looked is the overall poor patient adherence to noninvasive remote monitoring systems which may also limit their utility [5]. At this time the exact role of noninvasive telemonitoring remains undefined and as a standalone strategy may be insufficient for improving outcomes [10]. …”

Section: Rationale For An Invasive Approachmentioning

confidence: 99%

Implantable Cardiovascular Sensors and Computers: Interventional Heart Failure Strategies

Smith

Abraham

2012

Curr Cardiol Rep

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Despite evidence-based medical and pharmacologic advances the management of heart failure remains challenging, whether in the ambulatory setting where daily weight monitoring has failed, or in the inpatient setting where readmission rates and morbidity remains high. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates for heart failure in general. There may be a shift in the paradigm with respect to the treatment of heart failure, which may usher in an era of invasive heart failure therapies and specialists. Experimental invasive devices and monitors have the potential to be game-changing therapies, and cardiac resynchronization therapy has evolved beyond just resynchronization and has the potential to provide important real-time hemodynamic feedback.

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