The Experts below are selected from a list of 347124 Experts worldwide ranked by ideXlab platform
Christopher M Oconnor - One of the best experts on this subject based on the ideXlab platform.
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improving Heart Failure therapeutics development in the united states the Heart Failure collaboratory
Journal of the American College of Cardiology, 2018Co-Authors: Christopher M Oconnor, William T Abraham, Mitchell A Psotka, Mona Fiuzat, Joann Lindenfeld, Michael R Bristow, Daniel A Canos, Robert A Harrington, Matt Hillebrenner, Mariell JessupAbstract:The current Heart Failure clinical trial environment is strained by increasing complexity and cost, regulatory requirements, competing demands on stakeholders, implementation challenges, and decreasing patient and investigator participation. To begin the process of developing potentially effective strategies and tactics, stakeholders including patients; investigators; academic leaders; pharmaceutical and device industry representatives; society representatives; third-party payers; and government representatives from the U.S. Food and Drug Administration, National Institutes of Health, and Centers for Medicare and Medicaid Services convened in March of 2017. This paper summarizes the discussions, outlines current challenges and actionable opportunities, and makes targeted recommendations to achieve the goals of improving efficiency in clinical trials and speeding the development of effective Heart Failure therapies, including the formation of an organized Heart Failure Collaboratory.
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physician determined worsening Heart Failure a novel definition for early worsening Heart Failure in patients hospitalized for acute Heart Failure association with signs and symptoms hospitalization duration and 60 day outcomes
The Cardiology, 2010Co-Authors: Gad Cotter, Piotr Ponikowski, Marco Metra, Beth Davison Weatherley, Howard C Dittrich, Barry M Massie, Daniel M Bloomfield, Christopher M OconnorAbstract:Objectives: To evaluate physician-determined worsening Heart Failure (PD-WHF) in patients admitted with acute Heart Failure (AHF). Methods: The PROTECT pilot stud
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inotropic therapy for Heart Failure an evidence based approach
American Heart Journal, 2001Co-Authors: Michael G Felker, Christopher M OconnorAbstract:Abstract Background Agents that increase cardiac contractility (positive inotropes) have beneficial hemodynamic effects in patients with acute and chronic Heart Failure but have frequently led to increased mortality when given on a long-term basis. Despite this fact, inotropes remain commonly used in the management of Heart Failure. Methods We reviewed the available data on short- and long-term inotrope use in Heart Failure, emphasizing high-quality evidence on the basis of randomized trials that were powered to address clinical end points. Results Available data suggest that long-term inotropic therapy has a negative impact on survival in patients with Heart Failure, regardless of the agent used. The data that inotropic therapy improves quality of life are mixed. High-quality randomized evidence is lacking for the use of inotropes for other Heart Failure indications, such as for acute decompensations or as a "bridge to transplant." Conclusions On the basis of the available evidence, the routine use of inotropes as Heart Failure therapy is not indicated in either the acute or chronic setting. Potentially appropriate uses of inotropes include as temporary treatment of diuretic-refractory acute Heart Failure decompensations or as a bridge to definitive treatment such as revascularization or cardiac transplantation. Inotropes also may be appropriate as a palliative measure in patients with truly end-stage Heart Failure. A model of Heart Failure pathophysiologic features that combines an understanding of both hemodynamic and neurohormonal factors will be required to best develop and evaluate novel treatments for advanced Heart Failure. (Am Heart J 2001;142:393-401.)
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reduction in Heart Failure events by the addition of a clinical pharmacist to the Heart Failure management team results of the pharmacist in Heart Failure assessment recommendation and monitoring pharm study
JAMA Internal Medicine, 1999Co-Authors: Wendy A Gattis, David J Whellan, Vic Hasselblad, Christopher M OconnorAbstract:Background: The multidisciplinary approach to managing Heart Failure has been shown to improve outcomes. The role of a clinical pharmacist in treating Heart Failure has not been evaluated. Methods: One hundred eighty-one patients with Heart Failure and left ventricular dysfunction (ejection fraction ,45) undergoing evaluation in clinic were randomized to an intervention or a control group. Patients in the intervention group received clinical pharmacist evaluation, which included medication evaluation, therapeutic recommendations to the attending physician, patient education, and follow-up telemonitoring. The control group received usual care. The primary end point was combined all-cause mortality and Heart Failure clinical events. All clinical events were adjudicated by a blinded end point committee. Results: Baseline characteristics were similar except for slightly higher age in the intervention group. Median follow-up was 6 months. All-cause mortality and Heart Failure events were significantly lower in the intervention group compared with the control group (4 vs 16; P = .005). In addition, patients in the intervention group received higher angiotensin-converting enzyme inhibitor doses as reflected by the median fraction of target reached (25th and 75th percentiles), 1.0 (0.5 and 1) and 0.5 (0.1875 and 1) in the intervention and control groups, respectively (P,.001). The use of other vasodilators in angiotensin-converting enzyme inhibitor‐intolerant patients was higher in the intervention group (75% vs 26%; P = .02). Conclusions: Outcomes in Heart Failure can be improved with a clinical pharmacist as a member of the multidisciplinary Heart Failure team. This observation may be due to higher doses of angiotensin-converting enzyme inhibitors and/or closer follow-up. Arch Intern Med. 1999;159:1939-1945
John G F Cleland - One of the best experts on this subject based on the ideXlab platform.
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clinical outcome endpoints in Heart Failure trials a european society of cardiology Heart Failure association consensus document
European Journal of Heart Failure, 2013Co-Authors: Faiez Zannad, Stefan D Anker, John G F Cleland, Angeles Alonso Garcia, Paul W Armstrong, Gonzalo Calvo, Jay N Cohn, Kenneth Dickstein, Michael J Domanski, Inger EkmanAbstract:Endpoint selection is a critically important step in clinical trial design. It poses major challenges for investigators, regulators, and study sponsors, and it also has important clinical and practical implications for physicians and patients. Clinical outcomes of interest in Heart Failure trials include all-cause mortality, cause-specific mortality, relevant non-fatal morbidity (e.g. all-cause and cause-specific hospitalization), composites capturing both morbidity and mortality, safety, symptoms, functional capacity, and patient-reported outcomes. Each of these endpoints has strengths and weaknesses that create controversies regarding which is most appropriate in terms of clinical importance, sensitivity, reliability, and consistency. Not surprisingly, a lack of consensus exists within the scientific community regarding the optimal endpoint(s) for both acute and chronic Heart Failure trials. In an effort to address these issues, the Heart Failure Association of the European Society of Cardiology (HFA-ESC) convened a group of expert Heart Failure clinical investigators, biostatisticians, regulators, and pharmaceutical industry scientists (Nice, France, 1213 February 2012) to evaluate the challenges of defining Heart Failure endpoints in clinical trials and to develop a consensus framework. This report summarizes the groups recommendations for achieving common views on Heart Failure endpoints in clinical trials.
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Heart Failure as an endpoint in Heart Failure and non Heart Failure cardiovascular clinical trials the need for a consensus definition
European Heart Journal, 2008Co-Authors: Faiez Zannad, John G F Cleland, Bertram Pitt, Wendy Gattis Stough, Kirkwood F Adams, Nancy L Geller, Christian Torppedersen, Bridget Anne Kirwan, Ferenc FollathAbstract:Specific criteria have been established to define the occurrence of myocardial infarction (MI) and stroke in cardiovascular clinical trials, but there is not a consistent definition for Heart Failure. Heart Failure events appear to occur at a rate that is similar to stroke and MI in trials of hypertension, hyperlipidaemia, diabetes, and coronary Heart disease, yet a consistent approach to defining Heart Failure events has not yet been realized. The wide range of definitions used in clinical trials makes it difficult to interpret new data in the context of existing literature. This inconsistency has led to challenges in determining the incidence of Heart Failure in cardiovascular studies and the effects of interventions on these endpoints. This paper examines issues related to defining Heart Failure events in cardiovascular clinical trials and presents a definition to formally address this issue.
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prediction of mode of death in Heart Failure the seattle Heart Failure model
Circulation, 2007Co-Authors: Dariush Mozaffarian, David T Linker, Stefan D Anker, Inder S Anand, Aldo P Maggioni, Mark D Sullivan, Douglas L Mann, John G F Cleland, Peter E Carson, Bertram PittAbstract:Background— Prognosis and mode of death in Heart Failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive Failure of cardiac function (pump Failure). Prediction of mode of death may facilitate decisions about specific medications or devices. Methods and Results— We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in Heart Failure, to assess the mode of death in 10 538 ambulatory patients with New York Heart Association class II to IV Heart Failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16 735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-Failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P<...
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the warfarin aspirin study in Heart Failure wash a randomized trial comparing antithrombotic strategies for patients with Heart Failure
American Heart Journal, 2004Co-Authors: John G F Cleland, I N Findlay, Syed M Jafri, G C Sutton, Rodney H Falk, C J Bulpitt, C Prentice, Ian Ford, Adele Trainer, P A PoolewilsonAbstract:Abstract Background Heart Failure is commonly associated with vascular disease and a high rate of athero-thrombotic events, but the risks and benefits of antithrombotic therapy are unknown. Methods The current study was an open-label, randomized, controlled trial comparing no antithrombotic therapy, aspirin (300 mg/day), and warfarin (target international normalized ratio 2.5) in patients with Heart Failure and left ventricular systolic dysfunction requiring diuretic therapy. The primary objective was to demonstrate the feasibility and inform the design of a larger outcome study. The primary clinical outcome was death, nonfatal myocardial infarction, or nonfatal stroke. Results Two hundred seventy-nine patients were randomized and 627 patient-years exposure were accumulated over a mean follow-up time of 27 ± 1 months. Twenty-six (26%), 29 (32%), and 23 (26%) patients randomized to no antithrombotic treatment, aspirin, and warfarin, respectively, reached the primary outcome (ns). There were trends to a worse outcome among those randomized to aspirin for a number of secondary outcomes. Significantly ( P = .044) more patients randomized to aspirin were hospitalized for cardiovascular reasons, especially worsening Heart Failure. Conclusions The Warfarin/Aspirin Study in Heart Failure (WASH) provides no evidence that aspirin is effective or safe in patients with Heart Failure. The benefits of warfarin for patients with Heart Failure in sinus rhythm have not been established. Antithrombotic therapy in patients with Heart Failure is not evidence based but commonly contributes to polypharmacy.
Stefan D Anker - One of the best experts on this subject based on the ideXlab platform.
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management of Heart Failure patients with covid 19 a joint position paper of the chinese Heart Failure association national Heart Failure committee and the Heart Failure association of the european society of cardiology
European Journal of Heart Failure, 2020Co-Authors: Yuhui Zhang, Javed Butler, Andrew J.s. Coats, Stefan D Anker, Jing-yuan Mao, Zhe Zheng, Marianna Adamo, Giuseppe Ambrosio, Muhammad Shahzeb Khan, Ling BaiAbstract:The coronavirus disease 2019 (COVID-19) pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is causing considerable morbidity and mortality worldwide. Multiple reports have suggested that patients with Heart Failure (HF) are at a higher risk of severe disease and mortality with COVID-19. Moreover, evaluating and treating HF patients with comorbid COVID-19 represents a formidable clinical challenge as symptoms of both conditions may overlap and they may potentiate each other. Limited data exist regarding comprehensive management of HF patients with concomitant COVID-19. Since these issues pose serious new challenges for clinicians worldwide, HF specialists must develop a structured approach to the care of patients with COVID-19 and be included early in the care of these patients. Therefore, the Heart Failure Association of the European Society of Cardiology and the Chinese Heart Failure Association & National Heart Failure Committee conducted web-based meetings to discuss these unique clinical challenges and reach a consensus opinion to help providers worldwide deliver better patient care. The main objective of this position paper is to outline the management of HF patients with concomitant COVID-19 based on the available data and personal experiences of physicians from Asia, Europe and the United States.
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Heart Failure preventing disease and death worldwide
Esc Heart Failure, 2014Co-Authors: Piotr Ponikowski, Stefan D Anker, Khalid F Alhabib, Martin R Cowie, Thomas Force, Shengshou Hu, Tiny Jaarsma, Henry Krum, Vishal Rastogi, Luis Eduardo Paim RohdeAbstract:Heart Failure is a life-threatening disease and addressing it should be considered a global health priority. At present, approximately 26 million people worldwide are living with Heart Failure. The outlook for such patients is poor, with survival rates worse than those for bowel, breast or prostate cancer. Furthermore, Heart Failure places great stresses on patients, caregivers and healthcare systems. Demands on healthcare services, in particular, are predicted to increase dramatically over the next decade as patient numbers rise owing to ageing populations, detrimental lifestyle changes and improved survival of those who go on to develop Heart Failure as the final stage of another disease. It is time to ease the strain on healthcare systems through clear policy initiatives that prioritize Heart Failure prevention and champion equity of care for all. Despite the burdens that Heart Failure imposes on society, awareness of the disease is poor. As a result, many premature deaths occur. This is in spite of the fact that most types of Heart Failure are preventable and that a healthy lifestyle can reduce risk. Even after Heart Failure has developed, premature deaths could be prevented if people were taught to recognize the symptoms and seek immediate medical attention. Public awareness campaigns focusing on these messages have great potential to improve outcomes for patients with Heart Failure and ultimately to save lives. Compliance with clinical practice guidelines is also associated with improved outcomes for patients with Heart Failure. However, in many countries, there is considerable variation in how closely physicians follow guideline recommendations. To promote equity of care, improvements should be encouraged through the use of hospital performance measures and incentives appropriate to the locality. To this end, policies should promote the research required to establish an evidence base for performance measures that reflect improved outcomes for patients. Continuing research is essential if we are to address unmet needs in caring for patients with Heart Failure. New therapies are required for patients with types of Heart Failure for which current treatments relieve symptoms but do not address the disease. More affordable therapies are desperately needed in the economically developing world. International collaborative research focusing on the causes and treatment of Heart Failure worldwide has the potential to benefit tens of millions of people. Change at the policy level has the power to drive improvements in prevention and care that will save lives. It is time to make a difference across the globe by confronting the problem of Heart Failure. A call to action: policy recommendations We urge policymakers at local, national and international levels to collaborate and act on the following recommendations. Promote Heart Failure prevention Support the development and implementation of public awareness programmes about Heart Failure. These should define Heart Failure in simple and accessible language, explain how to recognize the symptoms and emphasize that most types of Heart Failure are preventable. Highlight the need for healthcare professionals across all clinical disciplines to identify patients with illnesses that increase the risk of Heart Failure and to prescribe preventive medications. Prioritize the elimination of infectious diseases in parts of the world where they still cause Heart Failure. Improve Heart Failure awareness amongst healthcare professionals Encourage the development and use of Heart Failure education programmes for all appropriate healthcare professionals. These should aim to improve the prevention, diagnosis, treatment and long-term management of Heart Failure and raise awareness of clinical practice guidelines. Ensure equity of care for all patients with Heart Failure Provide a healthcare system that delivers timely access to diagnostic services and treatment of Heart Failure, as well as a seamless transition to long-term management. Ensure that the best available and most appropriate care is consistently provided to all patients with Heart Failure through efficient use of resources. Support and empower patients and their caregivers Provide resources for the education and practical support of patients with Heart Failure and their families or other caregivers, empowering them to engage proactively in long-term care. Promote Heart Failure research Fund and encourage international collaborative research to improve understanding of the patterns, causes and effects of modern day Heart Failure and how the disease can be prevented across the globe. Fund and encourage research into new and more affordable therapies and medical devices for all types of Heart Failure. Fund and encourage research into evidence-based healthcare performance measures that reflect improved clinical outcomes for patients with Heart Failure.
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clinical outcome endpoints in Heart Failure trials a european society of cardiology Heart Failure association consensus document
European Journal of Heart Failure, 2013Co-Authors: Faiez Zannad, Stefan D Anker, John G F Cleland, Angeles Alonso Garcia, Paul W Armstrong, Gonzalo Calvo, Jay N Cohn, Kenneth Dickstein, Michael J Domanski, Inger EkmanAbstract:Endpoint selection is a critically important step in clinical trial design. It poses major challenges for investigators, regulators, and study sponsors, and it also has important clinical and practical implications for physicians and patients. Clinical outcomes of interest in Heart Failure trials include all-cause mortality, cause-specific mortality, relevant non-fatal morbidity (e.g. all-cause and cause-specific hospitalization), composites capturing both morbidity and mortality, safety, symptoms, functional capacity, and patient-reported outcomes. Each of these endpoints has strengths and weaknesses that create controversies regarding which is most appropriate in terms of clinical importance, sensitivity, reliability, and consistency. Not surprisingly, a lack of consensus exists within the scientific community regarding the optimal endpoint(s) for both acute and chronic Heart Failure trials. In an effort to address these issues, the Heart Failure Association of the European Society of Cardiology (HFA-ESC) convened a group of expert Heart Failure clinical investigators, biostatisticians, regulators, and pharmaceutical industry scientists (Nice, France, 1213 February 2012) to evaluate the challenges of defining Heart Failure endpoints in clinical trials and to develop a consensus framework. This report summarizes the groups recommendations for achieving common views on Heart Failure endpoints in clinical trials.
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prediction of mode of death in Heart Failure the seattle Heart Failure model
Circulation, 2007Co-Authors: Dariush Mozaffarian, David T Linker, Stefan D Anker, Inder S Anand, Aldo P Maggioni, Mark D Sullivan, Douglas L Mann, John G F Cleland, Peter E Carson, Bertram PittAbstract:Background— Prognosis and mode of death in Heart Failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive Failure of cardiac function (pump Failure). Prediction of mode of death may facilitate decisions about specific medications or devices. Methods and Results— We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in Heart Failure, to assess the mode of death in 10 538 ambulatory patients with New York Heart Association class II to IV Heart Failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16 735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-Failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P<...
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the seattle Heart Failure model prediction of survival in Heart Failure
Circulation, 2006Co-Authors: Wayne C Levy, Dariush Mozaffarian, David T Linker, Santosh C Sutradhar, Stefan D Anker, Anne B Cropp, Inder S Anand, Aldo P Maggioni, Paul B J Burton, Mark D SullivanAbstract:Background— Heart Failure has an annual mortality rate ranging from 5% to 75%. The purpose of the study was to develop and validate a multivariate risk model to predict 1-, 2-, and 3-year survival in Heart Failure patients with the use of easily obtainable characteristics relating to clinical status, therapy (pharmacological as well as devices), and laboratory parameters. Methods and Results— The Seattle Heart Failure Model was derived in a cohort of 1125 Heart Failure patients with the use of a multivariate Cox model. For medications and devices not available in the derivation database, hazard ratios were estimated from published literature. The model was prospectively validated in 5 additional cohorts totaling 9942 Heart Failure patients and 17 307 person-years of follow-up. The accuracy of the model was excellent, with predicted versus actual 1-year survival rates of 73.4% versus 74.3% in the derivation cohort and 90.5% versus 88.5%, 86.5% versus 86.5%, 83.8% versus 83.3%, 90.9% versus 91.0%, and 89.6%...
Marco Metra - One of the best experts on this subject based on the ideXlab platform.
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physician determined worsening Heart Failure a novel definition for early worsening Heart Failure in patients hospitalized for acute Heart Failure association with signs and symptoms hospitalization duration and 60 day outcomes
The Cardiology, 2010Co-Authors: Gad Cotter, Piotr Ponikowski, Marco Metra, Beth Davison Weatherley, Howard C Dittrich, Barry M Massie, Daniel M Bloomfield, Christopher M OconnorAbstract:Objectives: To evaluate physician-determined worsening Heart Failure (PD-WHF) in patients admitted with acute Heart Failure (AHF). Methods: The PROTECT pilot stud
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palliative care in Heart Failure a position statement from the palliative care workshop of the Heart Failure association of the european society of cardiology
European Journal of Heart Failure, 2009Co-Authors: Tiny Jaarsma, James M Beattie, Mary Ryder, Frans H Rutten, Theresa Mcdonagh, Paul Mohacsi, Scott A Murray, Thomas Grodzicki, Ingrid Bergh, Marco MetraAbstract:Heart Failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of Heart Failure patients receive specialist palliative care. Heart Failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in Heart Failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for Heart Failure patients and promoting the development of Heart Failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.
William T Abraham - One of the best experts on this subject based on the ideXlab platform.
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wireless hemodynamic monitoring in patients with Heart Failure
Current Heart Failure Reports, 2021Co-Authors: Matthew M Lander, Nael H Aldweib, William T AbrahamAbstract:PURPOSE OF REVIEW: Wireless hemodynamic monitoring in Heart Failure patients allows for volume assessment without the need for physical exam. Data obtained from these devices is used to assist patient management and avoid Heart Failure hospitalizations. In this review, we outline the various devices, mechanisms they utilize, and effects on Heart Failure patients. RECENT FINDINGS: New applications of these devices to specific populations may expand the pool of patients that may benefit. In the COVID-19 pandemic with a growing emphasis on virtual visits, remote monitoring can add vital ancillary data. Wireless hemodynamic monitoring with a pulmonary artery pressure sensor is a highly effective and safe method to assess for worsening intracardiac pressures that may predict Heart Failure events, giving lead time that is valuable to keep patients optimized. Implantation of this device has been found to improve outcomes in Heart Failure patients regardless of preserved or reduced ejection fraction.
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improving Heart Failure therapeutics development in the united states the Heart Failure collaboratory
Journal of the American College of Cardiology, 2018Co-Authors: Christopher M Oconnor, William T Abraham, Mitchell A Psotka, Mona Fiuzat, Joann Lindenfeld, Michael R Bristow, Daniel A Canos, Robert A Harrington, Matt Hillebrenner, Mariell JessupAbstract:The current Heart Failure clinical trial environment is strained by increasing complexity and cost, regulatory requirements, competing demands on stakeholders, implementation challenges, and decreasing patient and investigator participation. To begin the process of developing potentially effective strategies and tactics, stakeholders including patients; investigators; academic leaders; pharmaceutical and device industry representatives; society representatives; third-party payers; and government representatives from the U.S. Food and Drug Administration, National Institutes of Health, and Centers for Medicare and Medicaid Services convened in March of 2017. This paper summarizes the discussions, outlines current challenges and actionable opportunities, and makes targeted recommendations to achieve the goals of improving efficiency in clinical trials and speeding the development of effective Heart Failure therapies, including the formation of an organized Heart Failure Collaboratory.
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implantable hemodynamic monitoring for Heart Failure patients
Journal of the American College of Cardiology, 2017Co-Authors: William T Abraham, Leor PerlAbstract:Abstract Rates of Heart Failure hospitalization remain unacceptably high. Such hospitalizations are associated with substantial patient, caregiver, and economic costs. Randomized controlled trials of noninvasive telemedical systems have failed to demonstrate reduced rates of hospitalization. The Failure of these technologies may be due to the limitations of the signals measured. Intracardiac and pulmonary artery pressure–guided management has become a focus of hospitalization reduction in Heart Failure. Early studies using implantable hemodynamic monitors demonstrated the potential of pressure-based Heart Failure management, whereas subsequent studies confirmed the clinical utility of this approach. One large pivotal trial proved the safety and efficacy of pulmonary artery pressure–guided Heart Failure management, showing a marked reduction in Heart Failure hospitalizations in patients randomized to active pressure-guided management. “Next-generation” implantable hemodynamic monitors are in development, and novel approaches for the use of this data promise to expand the use of pressure-guided Heart Failure management.
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cardiac resynchronization therapy for Heart Failure
Circulation, 2003Co-Authors: William T Abraham, David L HayesAbstract:The weight of evidence supporting the routine use of cardiac resynchronization therapy, or atrial-synchronized biventricular pacing, as a treatment for patients with moderate-to-severe chronic systolic Heart Failure and ventricular dyssynchrony is now quite substantial. Results from mechanistic studies, observational evaluations, and randomized, controlled trials have consistently demonstrated significant improvement in quality of life, functional status, and exercise capacity in patients with New York Heart Association (NYHA) class III and IV Heart Failure who are assigned to active resynchronization therapy. 1–3 In these patients, cardiac resynchronization has also been shown to improve cardiac structure and function while significantly reducing the risk of worsening Heart Failure. 1,2 In 2001, the first resynchronization device became commercially available in the United States. The following year, 2 devices that combine biventricular pacing capability with implantable cardioverter defibrillators (ICDs) were approved for use by the US Food and Drug Administration. Recently updated ACC/AHA/ NASPE Pacemaker and ICD Guidelines included cardiac resynchronization therapy as a class IIA recommendation for pacing. 4 Since that time, preliminary results from another large-scale trial have suggested a significant reduction in the combined end point of all-cause mortality and all-cause hospitalization with cardiac resynchronization therapy in an advanced Heart Failure population. 5 The present article briefly reviews the rationale for and mechanisms of cardiac resynchronization therapy in Heart Failure as background to a more in-depth discussion of landmark clinical trials. Patient selection and limitations/pitfalls of resynchronization therapy are also discussed. Rationale for Cardiac Resynchronization Therapy Approximately one third of patients with systolic Heart Failure have a QRS duration greater than 120 ms, which is most commonly seen as left bundle-branch block (LBBB).6,7 In LBBB, the left ventricle is activated belatedly through the septum from the right ventricle, resulting in a significant delay between the onset of left ventricular (LV) and right ventricular contraction. 8,9 Activation of the anterior septum
