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Medical and Device Options for Patients with End-Stage Heart Failure

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Clinical Guide to Heart Transplantation

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Abstract

In modern times, heart failure has increasingly become a major public health issue, with a prevalence of approximately 5.1 million in North America [1]. Furthermore, one in 7 Americans are age 65 or greater, with this proportion set to rise to one in 5 by 2050 [2]. Given the age-dependent increase in incidence and prevalence of heart failure, the proportion of heart failure will only continue to increase; already, it is one of the main causes of death and hospitalization in this age group. Combined with demographic improvements in life expectancies and recent improvements in the treatment of heart-failure, the proportion of patients that develop advanced heart failure has also increased substantially. The majority of patients with so-called “end-stage” heart failure are characterized by advanced structural heart disease and profound symptoms of heart failure at rest or upon minimal exertion despite maximal guideline-directed medical treatment, and typically fall into stage D of the ABCD classification of the American College of Cardiology (ACC)/American Heart Association (AHA), and class III–IV of the New York Heart Association (NYHA) functional classification (see Table 1.2 for a full explanation of heart failure classifications). There are varying etiologies of such severe heart failure, which can broadly be divided into ischemic and non-ischemic; these may include unstable arrhythmias, idiopathic cardiomyopathies and many others. Regardless of the etiology, the subgroup of stage D heart failure demonstrates a particularly high 5-year mortality rate of 80% [1], and thus requires special therapeutic interventions. This chapter will assume background knowledge in the principles of heart failure and its early management, and will cover current medical and device strategies for the management of end-stage heart failure, with acknowledgement to the options of mechanical circulatory support and cardiac transplantation which will be covered in detail in upcoming chapters.

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Author information

Authors and Affiliations

  1. Heart Failure Program, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Michele Hamilton MD (Director)

  2. Heart Failure/Transplant Cardiologist, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Michelle Kittleson MD, PhD

  3. Director, Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Jon Kobashigawa MD

  4. Director, Heart Transplant Program, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Jon Kobashigawa MD

Authors
  1. Michele Hamilton MD
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  2. Michelle Kittleson MD, PhD
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  3. Jon Kobashigawa MD
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Corresponding author

Correspondence to Michele Hamilton MD .

Editor information

Editors and Affiliations

  1. Director, Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California, USA

    Jon Kobashigawa

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Hamilton, M., Kittleson, M., Kobashigawa, J. (2017). Medical and Device Options for Patients with End-Stage Heart Failure. In: Kobashigawa, J. (eds) Clinical Guide to Heart Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-43773-6_1

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  • DOI: https://doi.org/10.1007/978-3-319-43773-6_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43771-2

  • Online ISBN: 978-3-319-43773-6

  • eBook Packages: MedicineMedicine (R0)

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