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Management of Comorbidities in Heart Failure

Patients with heart failure (HF) often have multiple comorbid conditions that may interact with the syndrome of HF and/or the choice of therapies. Research into the common comorbid conditions has furthered the understanding of the pathophysiologic basis for symptoms or structural abnormalities of HF, aided in the refinement of the often-complicated management because of the competing therapies, and provided clarity regarding the diagnostic certainty (or uncertainty)…

Disease Management and Telemedicine in Heart Failure

Heart failure (HF) currently affects more than 5 million Americans, and because of the aging population and the expected growth of the US population, the prevalence of HF is expected to increase to more than 8 million Americans by 2030 ( see also Chapter 18 ). Projections show that the total cost of HF will increase to almost $70 billion per year by 2030. HF is…

Cardio-Oncology and Heart Failure

Heart failure (HF) as a consequence of cancer treatment is a well-known clinical challenge with a history as old as the earliest days of cytotoxic chemotherapies and radiation-based treatment. During the past several decades of advancement in cancer treatment with overall improvements in cancer survival, cardiovascular (CV) toxicities, specifically HF, have become increasingly recognized as a consequence of treatment with a diverse set of agents. Fortunately,…

Circulatory Assist Devices in Heart Failure

Management of advanced heart failure is often less evidence-based than earlier stages of the disease. By definition, these patients are typically failing evidence-based medical and electrical heart failure therapies, so there are few clinical trials to guide therapy. Professional societies have developed definitions of “advanced” heart failure, but all tend to share common data elements: objective evidence of ventricular dysfunction, marked functional limitations, evidence of volume…

Heart Transplantation

The first human heart transplant (HT) was performed more than 50 years ago, in 1967, by Christiaan Barnard at Groote Schuur Hospital in Cape Town, South Africa. Since that time over 100,000 lives have been saved by this procedure. Despite steady progress in the field of mechanical circulatory support (MCS), HT remains the therapy that provides the best quality of life and long-term survival for patients…

Pulmonary Hypertension

Pulmonary Hypertension: Definition and Classification Pulmonary hypertension (PH) is a hemodynamic finding and is considered to be present when the mean pulmonary artery pressure (mPAP) is greater than 20 mm Hg as recently defined by the Sixth World Symposium on Pulmonary Hypertension. Historically, PH has been defined as a mPAP ≥25 mm Hg, but the definition was recently re-evaluated and changed to a mPAP of >20…

Neuromodulation in Heart Failure

The autonomic nervous system (ANS) plays a vital role in the management of cardiac function. The subdivisions of the ANS are the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS; see also Chapter 13 ). The SNS is the stimulatory pathway. Increased sympathetic tone enhances AV conduction and myocardial contractility. The PNS activation of the heart occurs via the tenth cranial nerve, the vagus.…

Stem Cell-Based and Gene Therapies in Heart Failure

Cardiac Cell Therapy Myocardial infarction (MI), despite significant advances in acute reperfusion and chronic pharmacotherapy, remains a major cause of heart failure in the United States. The lost myocardium is replaced by fibrotic scar leading to progressive left ventricular (LV) remodeling and further dysfunction. Although limited myocyte turnover in the adult mammalian heart has been reported to occur at baseline, this intrinsic regenerative capacity is limited…

Management of Heart Failure in Special Populations : Older Patients, Women, and Racial/Ethnic Minority Groups

While heart failure (HF) affects all segments of the population, older patients, women, and racial and ethnic minority groups have been markedly underrepresented in most major HF trials. This chapter provides a brief summary of the epidemiology, clinical features, and management of HF in these large and important subgroups of the HF population. Heart Failure in Older Adults Epidemiology (see also Chapter 18 ) HF is…

Treatment of Heart Failure with Preserved Ejection Fraction

Over the past two decades, it has become increasingly apparent that approximately 50% of patients with heart failure (HF) have a normal or almost normal ejection fraction (see also Chapter 11 ), referred to variably as diastolic HF or HF with preserved ejection fraction (HFpEF). The prevalence of this condition is likely to keep increasing as the prevalence of the elderly with comorbid conditions increases. Although…

Management of Arrhythmias and Device Therapy in Heart Failure

Arrhythmias are common in heart failure patients. This chapter will discuss the diagnosis and therapy of arrhythmias in patients with heart failure. Atrial Fibrillation Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Its prevalence increases with age and with both systolic and diastolic heart failure. It has been reported that up to 25% of patients with chronic heart failure will have permanent AF. AF…

Contemporary Medical Therapy for Heart Failure Patients with Reduced Ejection Fraction

Heart failure (HF) is a complex clinical syndrome that represents a final common pathway for many types of cardiovascular disease. Multiple overlapping frameworks for classifying HF exist ( see also Chapters 18, Chapter 31 ). HF can be viewed as a continuum that is comprised of four interrelated stages as defined by the American College of Cardiology and the American Heart Association (ACC/AHA) Guidelines ( Fig.…

Acute Heart Failure

Nearly one third of acute heart failure (AHF) patients die or are rehospitalized within 90 days after discharge in the United States, with similar numbers in Europe. Despite a decade of intensive research efforts, substantially improving outcomes remains an elusive goal. Reducing morbidity and mortality remains the greatest current challenge of AHF management. Background and Epidemiology More than 6.5 million Americans have heart failure (HF), with…

Disease Prevention in Heart Failure

Prevention of heart failure is an urgent public health need with national and global implications. Despite recent advances in the therapy of cardiovascular disorders, heart failure remains a challenging disease with a high prevalence ( Fig. 35.1 ) and a dismal long-term prognosis. On the basis of data from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2014, an estimated 6.5 million Americans 20…

Hemodynamics in Heart Failure

The first right heart catheterization (RHC) in humans was performed in 1929 by Dr. Werner Forssmann (on himself), who ultimately shared in the 1956 Nobel Prize in Medicine with Andre Cournard and Dickinson Richards for their work in cardiac catheterization. RHC was further refined by the work of Drs. Bradley and Fife, and in 1969 Drs. Scheinman, Abbot, and Rapaport reported their use of a flow-directed…

Biomarkers and Precision Medicine in Heart Failure

Acknowledgments Dr. Ibrahim is supported in part by the Dennis and Marilyn Barry Fellowship in Cardiology Research. Dr. Gaggin is supported in part by the Ruth and James Clark Fund for Cardiac Research Innovation. Dr. Januzzi is supported in part by the Hutter Family Professorship. The underlying mechanisms in the development and progression of heart failure (HF) are complex and involve an intricate interplay of cardiac…

Cardiac Imaging in Heart Failure

Definition of Heart Failure Heart failure can be defined as a clinical syndrome caused by an abnormality of cardiac structure or function that results in failure to deliver oxygen at a rate commensurate with the needs of the body tissues (systolic failure), or failure to receive blood at normal filling pressures (diastolic failure). The diagnosis of heart failure may be difficult to establish clinically, especially during…

Clinical Evaluation of Heart Failure

Introduction and Goals of Clinical Evaluation Optimal implementation of heart failure therapy requires expeditious and accurate diagnosis as well as determination of the severity of the disease and, wherever possible, identification of its cause. The earlier in the clinical course that providers recognize the presence and stage of heart failure, the more likely that appropriate treatments will be initiated in a timely manner. In addition, since…

Heart Failure and Human Immunodeficiency Virus

What Is Human Immunodeficiency Virus-Associated Heart Failure? As antiretroviral therapy (ART) has become widely adopted, acquired immune deficiency syndrome (AIDS)–defining infections and malignancies have become less common, and the burden of chronic noncommunicable diseases has increased. Parallel to this transition, human immunodeficiency virus (HIV)–associated heart failure (HF) has evolved from an end-stage AIDS-related complication to a more heterogeneous disease state representing diverse HIV-related pathophysiologies. HF is…

Heart Failure in the Developing World

Heart Failure: a Global Perspective At any one time it has been estimated there are approximately 26 million cases of heart failure globally. Although many of these cases reside in the developing world, our understanding of heart failure is largely framed by studies undertaken in high-income countries. The characteristics and consequences of heart failure have also been framed by its clinical diagnosis (with normal values for…