Advanced Therapies For End-Stage Heart Failure
Jason N. Katz,
Sarah B. Waters,
Ian B. Hollis,
Patricia P. Chang.
Management of the advanced heart failure patient can be complex. Therapies include cardiac transplantation
and mechanical circulatory support, as well inotropic agents for the short-term. Despite a growing armamentarium of resources,
the clinician must carefully weigh the risks and benefits of each therapy to develop an optimal treatment strategy.
While cardiac transplantation remains the only true “cure” for end-stage disease, this resource is limited and the demand
continues to far outpace the supply. For patients who are transplant-ineligible or likely to succumb to their illness prior to
transplant, ventricular assist device therapy has now become a viable option for improving morbidity and mortality. Particularly
for the non-operative patient, intravenous inotropes can be utilized for symptom control. Regardless of the treatments
considered, care of the heart failure patient requires thoughtful dialogue, multidisciplinary collaboration, and individualized
care. While survival is important, most patients covet quality of life above all outcomes. An often overlooked
component is the patient’s control over the dying process. It is vital that clinicians make goals-of-care discussions a priority
when seeing patients with advanced heart failure. The use of palliative care consultation is well-validated and facilitates
these difficult conversations to ensure that all patient needs are ultimately met.
Keywords: Cardiac transplantation, end-stage heart failure, inotrope, palliative care, ventricular assist device.
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