iDeNtiFyiNG caNDiDates FOr heart Failure Device therapies Device … · 2019. 12. 5. · 12 Linde...
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DEVICE THERAPIES AVAILABLE FOR INDICATED HEART FAILURE PATIENTS WHEN TO CONSIDER CRT OR ICD DEVICE THERAPY? MEDICATION ALONE IS NOT ENOUGH TO HELP ALL HEART FAILURE PATIENTS SCREENLINK WHEN TO CONSIDER VAD THERAPY? IDENTIFYING CANDIDATES FOR HEART FAILURE DEVICE THERAPIES BASED ON THE 2016 ESC HF GUIDELINES 1
Transcript of iDeNtiFyiNG caNDiDates FOr heart Failure Device therapies Device … · 2019. 12. 5. · 12 Linde...
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
screeNliNk
WheN tO cONsiDer vaD therapy?
iDeNtiFyiNG caNDiDates FOr heart Failure Device therapiesBASED ON THE 2016 ESC HF GUIDELINES1
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
screeNliNk
Device therapies available FOr iNDicateD heart Failure patieNts
Device therapies available FOr iNDicateDheart Failure patieNts1
Implantable CardIoverterdefIbrIllator (ICD)
CardIaC resynChronIsatIon therapy (CRT)
ventrICular assIst devICe (VAD)
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
crt vaD
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icD
Device therapies available FOr iNDicateD heart Failure patieNts
Device therapies available FOr iNDicateDheart Failure patieNts1
§ Implantable device which detects life-threatening arrhythmias which may affect some HF patients and delivers therapy, either as an electric shock or as specialised pacing
§ The risk for life-threatening arrhythmias is typically assessed via EF measurement, EP studies and family history
§ ICD reduces the risk of sudden cardiac death1
Implantable CardIoverterdefIbrIllator(ICD)
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
icD vaD
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crt
Device therapies available FOr iNDicateD heart Failure patieNts
Device therapies available FOr iNDicateDheart Failure patieNts1
§ Implantable device which paces both ventricles, correcting electrical dyssynchrony typically diagnosed on ECG using QRS duration
§ CRT-D devices combine CRT pacing therapy and ICD therapy
§ CRT reduces the risk of death and of hospitalisation, improves left ventricular systolic function, symptoms and quality of life1-12
CardIaC resynChronIsatIon therapy (CRT)
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
icD crt
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vaD
Device therapies available FOr iNDicateD heart Failure patieNts
Device therapies available FOr iNDicateDheart Failure patieNts1
§ Mechanical pump. When one of the ventricles doesn’t perform well, a VAD may be used to assist the heart by increasing the amount of blood that flows out to the body
§ The VAD is surgically implanted in the chest to assist the heart in pumping blood. It is connected directly to the heart at the bottom of the ventricle. From here, it draws oxygen-rich blood through the pump and pushes it into the aorta. Once blood reaches the aorta, it can flow to the rest of the body
§ VAD improves survival, symptoms and quality of life for patients with endstage heart failure, both in the bridge to transplant and in the destination therapy indication1
ventrICular assIst devICe (VAD)
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
screeNliNk
WheN tO cONsiDer crt Or icD Device therapy?
WheN tO cONsiDercrt Or icD Device therapy?
hFreF: Heart Failure with reduced Ejection FractioneF: Ejection Fractionlbbb: Left Bundle Branch BlockMi: Myocardial Infarction
cardiac resynchronization therapy
implantable cardioverter Defibrillator
* The choice between CRT-P and CRT-D should be discussed with the physician & patient in each individual case
icDs are also strongly recommended for secondary prevention in patients who have recovered from a ventricular arrhythmia causing haemodynamic instability & who are expected to survive >1 year with good functional status.
EF ≤ 35%
ischaemic heart disease
Dilated cardiomyopathy
No Mi within last 40 dayslbbb Non-lbbb
ICd reCommended
life expectancy >1 year
QRS ≥130 ms
QRS <130 ms
CRT-D or CRT-P* reCommended
CRT-D or CRT-P* to be ConsIdered
patients with hFreF and a need for pacing are also candidates for crt regardless of hYha class. this includes aF patients.
patient with symptomatic hFreF (NYha ii-iv) in sinus rhythm, on optimal medical therapy (≥ 3 months)
Click to enlarge the picture
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
screeNliNk
WheN tO cONsiDer vaD therapy?
WheN tO cONsiDervaD therapy?
LVEF ≤ 25% Number of rehospitalizations for HF in 12 Months ≥ 3
Dependance on intravenous inotropic therapy
progressive end-organ dysfunction (worsening renal and/or hepatic function) due to reduced perfusion and not to inadequate ventricular filling pressure (PCWP ≥ 20 mmHg and SBP ≤ 80-90 mmHg or CI ≤ 2 L/min/m2)
absence of severe right ventricular dysfunction together with severe tricuspid regurgitation
aND/Or aND/Or aND/Or aND/Or
heartWare™ hvaD™ pump
vad therapy to be ConsIdered
ventricular assist Device
lveF: Left Ventricular Ejection FractionpcWp: Pulmonary Capillary Wedge Pressuresbp: Systolic Blood Pressureci: Cardiac Index
patient with severely symptomatic hFreF (NYha iv) on optimal medical therapy ≥ 2 months
Click to enlarge the picture
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
WheN tO cONsiDer vaD therapy?
screeNliNk
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
MeDicatiON alONeis NOt eNOUGhtO help all heart Failure patieNts
some of your patients could have electrical dyssynchrony (indicators include LBBB or QRS ≥ 130 ms) and may benefit from cardiac resynchronization therapy (crt)
crt is the ONlY prOveN WaYtO aDDress electricalDyssyNchrONy1
at least 20% of heart failure patients are candidates for Crt2
Crt, in addition to guideline-directed medical therapy, is clinically proven to help:
§ improve quality of life 3,4
§ slow heart Failure disease progression 5
§ Decrease mortality 6-11
§ reduce heart Failure hospitalizations 7-10,12
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
screeNliNk
WheN tO cONsiDer vaD therapy?
please refer to the screenlink calculator to screen patients according to the latest heart Failure Guidelines.
Download it from the app store and Google play or visit www.screenlinkcalculator.com
available iN7 laNGuaGes
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
screeNliNk
WheN tO cONsiDer vaD therapy?
For applicable devices, consult instructions for use at this website. Manuals can be viewed using a current version of any major Internet browser. For best results, use Adobe Acrobat Reader® with the browser.The HeartWare™ HVAD™ System IFU can be found at www.heartware.com/clinicians/instructions-use.
indications, safety, and WarningsSee the device manual for detailed information regarding the instructions for use, the implant procedure, indications, contraindications, warnings, precautions, and potential adverse events. If using an MRI SureScan® device, see the MRI SureScan® Technical manual before performing an MRI. For further information, contact your local Medtronic representative and/or consult the Medtronic website at www.medtronic.com.
important reminder: This information is intended only for users in markets where Medtronic products and therapies are approved or available for use as indicated within the respective product manuals. Content on specific Medtronic products and therapies is not intended for users in markets that do not have authorization for use.
www.medtronic.com/manuals
references1 Ponikowski et al. European Heart Journal doi:10.1093/eurheartj/ehw1282 Jaffe LM, et al. The Ochsner Journal. 2014;14:596-607.3 Abraham WT, et al. N Engl J Med. 2002;346:1845-1853.4 Young JB, et al. JAMA. 2003;289:2685-2694.5 Gold MR, et al. JACC Heart Fail. 2015;3:691-700.6 Cleland JG, et al. Eur Heart J. 20 06;27:1928-1932.7 Bristow MR, et al. N Engl J Med. 20 04;350:2140-2150.8 Cleland JG, et al. N Engl J Med. 2005;352:1539-1549.9 Moss A, et al. N Engl J Med. 2009;361:1329-1338.10 Tang AS, et al. N Engl J Med. 2010;363:2385-2395.11 Curtis AB, et al. N Engl J Med. 2013;368:1585-1593. 12 Linde C, et al. J Am Coll Cardiol. 20 08;2:1834-1843.
note: this document does not replace current guidelines. It is intended as an initial help for referral physicians. The full guidelines can be found here: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
UC201909229EE © Medtronic 2018. All rights reserved.
medtronic.eu
europeMedtronic International Trading Sàrl.Route du Molliau 31Case postaleCH-1131 TolochenazTel: +41 (0)21 802 70 00Fax: +41 (0)21 802 79 00
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
screeNliNk
WheN tO cONsiDer crt Or icD Device therapy?
WheN tO cONsiDercrt Or icD Device therapy?
XclosehFreF: Heart Failure with reduced Ejection FractioneF: Ejection Fractionlbbb: Left Bundle Branch BlockMi: Myocardial Infarction
cardiac resynchronization therapy
implantable cardioverter Defibrillator
* The choice between CRT-P and CRT-D should be discussed with the physician & patient in each individual case
icDs are also strongly recommended for secondary prevention in patients who have recovered from a ventricular arrhythmia causing haemodynamic instability & who are expected to survive >1 year with good functional status.
EF ≤ 35%
ischaemic heart disease
Dilated cardiomyopathy
No Mi within last 40 dayslbbb Non-lbbb
ICd reCommended
life expectancy >1 year
QRS ≥130 ms
QRS <130 ms
CRT-D or CRT-P* reCommended
CRT-D or CRT-P* to be ConsIdered
patients with hFreF and a need for pacing are also candidates for crt regardless of hYha class. this includes aF patients.
patient with symptomatic hFreF (NYha ii-iv) in sinus rhythm, on optimal medical therapy (≥ 3 months)
Device therapies available FOr iNDicateD heart Failure patieNts
WheN tO cONsiDer crt Or icD Device therapy?
MeDicatiON alONe is NOt eNOuGh tO help all heart Failure patieNts
WheN tO cONsiDer vaD therapy?
screeNliNk
WheN tO cONsiDer vaD therapy?
WheN tO cONsiDervaD therapy?
Xclose
LVEF ≤ 25% Number of rehospitalizations for HF in 12 Months ≥ 3
Dependance on intravenous inotropic therapy
progressive end-organ dysfunction (worsening renal and/or hepatic function) due to reduced perfusion and not to inadequate ventricular filling pressure (PCWP ≥ 20 mmHg and SBP ≤ 80-90 mmHg or CI ≤ 2 L/min/m2)
absence of severe right ventricular dysfunction together with severe tricuspid regurgitation
aND/Or aND/Or aND/Or aND/Or
heartWare™ hvaD™ pump
vad therapy to be ConsIdered
ventricular assist Device
lveF: Left Ventricular Ejection FractionpcWp: Pulmonary Capillary Wedge Pressuresbp: Systolic Blood Pressureci: Cardiac Index
patient with severely symptomatic hFreF (NYha IV) on optimal medical therapy ≥ 2 months
