scholarly journals Treatment and management of advanced heart failure in elderly

2019 ◽  
Vol 89 (1) ◽  
Author(s):  
Nidal Tourkmani
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Health Care Professionals ◽  
The Elderly ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
High Morbidity ◽  
Open Communication ◽  
Limiting Condition ◽  
End Stage

Heart failure (HF) is a life-limiting condition, associated with high morbidity. End-stage, known as advanced heart failure (AHF), is more common among the elderly. HF patients’ disease trajectory is more variable and unpredictable than the trajectory for most oncologic illnesses. Despite a growing armamentarium of resources the management of AHF patients can be complex. Advances in medical therapy have dramatically improved the quality of life and survival of patients with end-stage HF. The majority of studies reveal lack of knowledge of HF among elderly patients. Mechanical circulatory support can provide bridge-to-transplantation therapy in eligible patients or destination therapy in those ineligible for heart transplantation like the majority of elderly patients with HF. The palliative care stage, considered as treatment basically aimed at controlling symptoms, may last a long time in some patients and should not simply be regarded as the final phase. Studies show that patients with AHF may have a poor understanding of their condition and its outcome and, therefore, guidelines recommend health care professionals to have an open communication with patients and their families about the AHF trajectory, including discussing their preferences for future care, acknowleding the risk of a sudden death, and the possibility of deactivation of devices (i.e. implantable defibrillators) in the end-of-life. This contribution is an attempt to have a brief overview of strategies for the management of HF terminal stage in elderly.

“I Just Feel Like I Always Did”: Inotropic Dependency at End of Life

2019 ◽  
Vol 37 (7) ◽  
pp. 497-502
Author(s):  
Abigail Latimer ◽  
Natalie D. Pope ◽  
Jessica M. McFarlin
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Health Care Professionals ◽  
Treatment Options ◽  
Advanced Heart Failure ◽  
Inotropic Support ◽  
Circulatory Support ◽  
Inotropic Therapy ◽  
Her Family ◽  
End Stage

Background: Patients not considered for mechanical circulatory support or heart transplant may be dependent on inotropic therapy at end of life. End-of-life conversations in advanced heart failure can be challenging for providers, but guidelines recommend frequent goals-of-care conversations when inotropes are used as a palliative treatment. The purpose of this study was to identify aspects of care pertinent for health-care professionals working with patients in end-stage heart failure who are receiving continuous inotropic support. Methods: Qualitative analysis was used to examine 3 audio-recorded semistructured interviews with 1 patient, her family, and her cardiologist. The selected patient was an older adult, diagnosed with advanced heart failure, and dependent on continuous inotropic therapy with no other advanced treatment options available. Results: The analysis revealed that (1) reliance on others, (2) contending with uncertainty, and (3) deciding when to discontinue inotropic support were identified as themes central to the patient’s and provider’s experience. Conclusion: This study offers insight into how to best support and communicate with patients having advanced heart failure who are dependent on continuous inotropic therapy at end of life.

Abstract 15170: In-hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jelani Grant ◽  
Louis Vincent ◽  
Bertrand Ebner ◽  
Jennifer Maning ◽  
Igor Vaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Experiences ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
High Morbidity ◽  
Palliative Care Consultation ◽  
Care Consultation

Introduction: Hospitalizations associated with advanced heart failure (HF) requiring mechanical circulatory support (MCS) are usually associated with a high morbidity, mortality and a protracted hospital course. Prior studies have shown that the early inclusion of palliative care specialist is associated with better end-of-life experiences. Methods: The National Inpatient Sample Database was queried from 2012 to 2017 for relevant International Classification of Diseases (ICD)-9 and ICD-10 procedural and diagnostic codes to identify patients above 18 years with advanced HF admitted with cardiogenic shock requiring MCS. Baseline characteristics and in-hospital outcomes were compared among patients evaluated by palliative care and those who were not. A p-value of <0.001 was considered statistically significant. Results: There were 748,360 patients hospitalized for advanced HF complicated by cardiogenic shock requiring MCS, of these a palliative care consult was placed in 118,015 (15.8%) patients. Patients evaluated by palliative care were older (70.6±14.9 vs. 64.9±16.3 years old, p<0.001) and had a higher prevalence of atrial fibrillation (39.3 vs. 35.1%,p<0.001) and chronic kidney disease (40.4 vs. 33.3, p<0.001), however had lower hypertension (57.4 vs. 59.7%, p<0.001), diabetes (35.4 vs. 36.5%, p<0.001), coronary artery disease (51.2 vs. 58.4%, p<0.001) and acute coronary syndromes (39.2 vs. 45.0%, p<0.001). Consulting palliative care was associated with a shorter length of stay (8.8±12.0 vs. 11.9±15.5 days, p<0.001), lower total hospital cost ($161,972±265,156 vs. $219,114±318,387, p<0.001) and higher Do Not Resuscitate (DNR) orders (30.8 vs. 5.8%, p<0.001). Mortality rates were higher in the palliative care cohort (73.4 vs. 29.4%, p<0.001). Conclusions: Despite the high morbidity and mortality associated with advanced HF patients with cardiogenic shock requiring MCS, the overall prevalence of palliative care consultation is exceedingly low. DNR orders were more prevalent in patients seen by the palliative care service. This study highlights the underutilization of palliative care services in this patient population, precluding any perceived benefit in end of life experiences.

scholarly journals Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Keith M. Swetz ◽  
John M. Stulak ◽  
Shannon M. Dunlay ◽  
Ellin F. Gafford
Keyword(s):  
Heart Failure ◽  
Ethical Issues ◽  
The Elderly ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Future Directions ◽  
Goods And Services ◽  
Mechanical Circulatory Support Devices ◽  
Made In

Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

scholarly journals Advanced Heart Failure and End-Stage Heart Failure: Does a Difference Exist

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 170 ◽  
Author(s):  
Severino ◽  
Mather ◽  
Pucci ◽  
D’Amato ◽  
Mariani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Clinical Symptoms ◽  
Advanced Heart Failure ◽  
Correct Selection ◽  
Circulatory Support ◽  
Advanced Therapy ◽  
The Right ◽  
End Stage

Advanced heart failure (AdHF) represents a challenging aspect of heart failure patients. Because of worsening clinical symptoms, high rates of re-hospitalization and mortality, AdHF represents an unstable condition where standard treatments are inadequate and additional interventions must be applied. A heart transplant is considered the optimal therapy for AdHF, but the great problem linked to the scarcity of organs and long waiting lists have led to the use of mechanical circulatory support with ventricular-assist device (VAD) as a destination therapy. VAD placement improves the prognosis, functional status, and quality of life of AdHF patients, with high rates of survival at 1 year, similar to transplant. However, the key element is to select the right patient at the right moment. The complete assessment must include a careful clinical evaluation, but also take into account psychosocial factors that are of crucial importance in the out-of-hospital management. It is important to distinguish between AdHF and end-stage HF, for which advanced therapy interventions would be unreasonable due to severe and irreversible organ damage and, instead, palliative care should be preferred to improve quality of life and relief of suffering. The correct selection of patients represents a great issue to solve, both ethically and economically.

106 Precipitating factors in the elderly patients admitted with the diagnosis of heart failure. Are easy to find?

2006 ◽  
Vol 5 (1) ◽  
pp. 25-26
Author(s):  
R VIDALPEREZ ◽  
E ABUASSI ◽  
M PARAMODEVEGA ◽  
P VELOSO ◽  
A VARELAROMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
The Elderly ◽  
Precipitating Factors

Chronic Mechanical Circulatory Support for Patients with End-stage Heart Failure as a Definitive Treatment Option

2010 ◽  
Vol 6 (4) ◽  
pp. 22
Author(s):  
Patrycja Ganslmeier ◽  
Christof Schmid ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Definitive Treatment ◽  
Circulatory Support ◽  
Randomized Evaluation ◽  
Fda Approval ◽  
Cerebrovascular Events ◽  
Device Placement ◽  
End Stage Heart Failure ◽  
End Stage

Mechanical circulatory support for end-stage heart failure has become routine and is now increasingly used as definitive treatment. Several small devices qualify for this purpose, but only a few have gained US Food and Drug Administration (FDA) approval as yet. Several studies, including the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study, the Investigation of Non-transplant-Eligible Patients Who Are Inotrope Dependent (INTrEPID) and the HeartMate (HM) II trial have confirmed a significantly improved quality of life and functional capacity after device placement. However, cerebrovascular events, infection and device malfunction still pose a considerable risk to patients and hinder widespread use.

scholarly journals A case report of cobalt cardiomyopathy leading to electric storm and cardiogenic shock: the importance of the orthopaedic background in patients with heart failure of unknown aetiology

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Cristina Castrillo Bustamante ◽  
Ángela Canteli Álvarez ◽  
Virginia Burgos Palacios ◽  
Jose Aurelio Sarralde Aguayo ◽  
David Serrano Lozano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Hip Prosthesis ◽  
Rare Condition ◽  
Restrictive Cardiomyopathy ◽  
Circulatory Support ◽  
Metal Levels ◽  
Common Causes ◽  
End Stage ◽  
Hip Arthroplasties

Abstract Background  The first series of cobalt cardiomyopathy was described in the 60s in relation to the abuse of a cobalt containing beer. Since then, millions of metal hip arthroplasties have been performed and a small number of cobalt cardiomyopathies related to metal prosthesis have been reported. Case summary  We report a case of a 48-year-old man who developed a severe non-dilated restrictive cardiomyopathy in the setting of a systemic metallosis following several hip arthroplasties. The diagnosis was suspected by exclusion of other more common causes for restrictive cardiomyopathies and confirmed by the levels of cobalt and chromium in the serum and the endomyocardial biopsy performance that showed metal deposits in myocardial tissue. Despite the removal of the metal prosthesis and a significant decrease in serum metal levels, he suffered cardiogenic shock (CS) and electric storm that required emergency mechanical circulatory support as a bridge to heart transplant. Discussion  Cobalt cardiomyopathy is a rare condition that has been observed in patients who develop cobalt toxicity after metal hip arthroplasty. The condition may improve after diagnosis and removal of the prosthesis or get worse and progress to end-stage heart failure or CS. The concern about the metal toxicity associated with metal hip prosthesis has increased in the last few years. Orthopaedic surgeons and cardiologists should be aware of this severe complication that is probably under diagnosed.

scholarly journals Complications and outcome of the long-term use of the intra-aortic balloon pump in patients with end-stage heart failure

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Stratinaki ◽  
E Bousoula ◽  
I Malakos ◽  
M Zymatoura ◽  
E Fountas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pharmacological Therapy ◽  
Circulatory Support ◽  
Intra Aortic Balloon Pump ◽  
Funding Sources ◽  
Iabp Support ◽  
End Stage Heart Failure ◽  
The Mean ◽  
End Stage

Abstract Funding Acknowledgements Type of funding sources: None. Background Intra-aortic balloon pump (IABP) can be used as circulatory support in order to stabilize haemodynamically compromised patients as either a bridge to therapy or to further mechanical support. Based on the current literature its use should be limited to up to two weeks and there are not enough data regarding its long term use’s efficacy and possible complications. Purpose To review the possible complications of the long-term use of IABP Methods We restrospectively analysed the data from 24 consecutive patients with end-stage heart failure (ESHF) who received long-term IABP support and recorded the complications during their hospitalization as well as their outcome. Results 24 patients (14 male and 10 female) were included. In 5 of them ESHF was attributed to ischemic cardiomyopathy and the in 19 to dilated cardiomyopathy. Their mean age was 45.6+/-14 years. The mean duration of IABP support was 70.2 days (minimum 30days maximum 192 days). The mean ejection fraction (EF) was 20%. Regarding the pharmacological therapy, 12/24 patients were on dobutamine, 4/24 on dobutamine and milrinone and 8/24 on dobutamine and noradrenaline. Regarding the clinical course of these patients, 7/24 underwent heart transplantation, 2/24 managed to wean from IABP, 5/24 received left lentrivular assist device (LVAD), 6/24 received biventricular assist veice (BiVAD) and 4/24 died. In terms of complications they were recorded as following : infection 7/24, bleeding 3/24, thrombosis 4/24, heparin-induced thrombocytopenia(HIT) 5/24, hematoma 4/24, ischemia 0/24 and rupture 1/24. Conclusions   Although not indicated by the current guidelines, long term IABP can be used as a relatively safe  circulatory support method.

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