Chronic heart failure management and remote haemodynamic monitoring

Abstract

Heart failure (HF) has a large societal and economic burden and is expected to increase in magnitude and complexity over the ensuing years. A number of telemonitoring strategies exploring remote monitoring and management of clinical signs and symptoms of congestion in HF have had equivocal results. Early studies of remote haemodynamic monitoring showed promise, but issues with device integrity and implantation-associated adverse events hindered progress. Nonetheless, these early studies established that haemodynamic congestion precedes clinical congestion by several weeks and that remote monitoring of intracardiac pressures may be a viable and practical management strategy. Recently, the safety and efficacy of remote pulmonary artery pressure-guided HF management was established in a prospective, single-blind trial where randomisation to active pressure-guided HF management reduced future HF hospitalisations. Subsequent commercial use studies reinforced the utility of this technology and post hoc analyses suggest that tight haemodynamic management of patients with HF may be an additional pillar of therapy alongside established guideline-directed medical and device therapy. Currently, there is active exploration into utilisation of this technology and management paradigm for the timing of implantation of durable left ventricular assist devices (LVAD) and even optimisation of LVAD therapy. Several ongoing clinical trials will help clarify the extent and utility of this strategy along the spectrum of patient with HF from individuals with chronic, stable HF to those with more advanced disease requiring heart replacement therapy.

Machine Learning–Driven Models to Predict Prognostic Outcomes in Patients Hospitalized With Heart Failure Using Electronic Health Records: Retrospective Study

“…HF is characterized by complex therapeutic regimens, frequent hospitalizations, and a poor prognosis, resulting in a tremendous health care burden [3]. In certain instances, these issues are also fundamental targets of a strategy for HF prevention and treatment [4,5]. It is crucial to discriminate accurately among patients with HF to identify those who have a high risk of in-hospital mortality and readmission, as well as to guide the use of different therapies based on patients' features.…”

Effects of ivabradine hydrochloride combined with trimetazidine on myocardial fibrosis in rats with chronic heart failure

“…A study (21) has shown that Iva could inhibit the oxidative stress reaction of myocardial cells in CHF rats, and another study (22) also showed that trimetazidine, as a new anti-myocardial ischemia drug, also had the function of oxygen free radical inhibition, oxidation resistance and apoptosis, which partially explained the changes in SOD expression in our conclusion. It was considered that (23) TGF-β1, a multifunctional regulatory factor, could affect MF through Smads-dependent and Smads-independent pathways. There is also a study (24) showing that excessive synthesis and deposition of COL-I promoted MF in patients with hypertension and heart failure.…”

Cardiac Implantable Electronic Miniaturized and Micro Devices

“…The leading concept behind these intra-cardiac devices for HF monitoring is that cardiac filling pressure increases days to weeks before overt clinical exacerbation occurs [ 86 , 87 ]. Several technologies were developed over the past decade in order to accurately measure pressure at different sites along the cardiac circulation and transmit this information to a care facility, where care-givers can appropriately react by changing the treatment dose and strategy [ 87 , 88 ].…”