Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology
Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology
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DOI：
10.1002/ejhf.1236
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发表时间：
2018-11-01
影响因子：
18.2
通讯作者：
Ruschitzka, Frank
中科院分区：
文献类型：
--
作者：
Crespo-Leiro, Maria G.;Metra, Marco;Ruschitzka, Frank
本文更新了欧洲心脏病学会 (ESC) 心力衰竭协会 2007 年晚期心力衰竭的分类，并描述了这些患者的新诊断和治疗方案。识别晚期心力衰竭患者对于及时转诊至晚期心力衰竭中心至关重要。因心力衰竭失代偿、恶性心律失常、合并症而进行的计划外就诊以及 2016 年 ESC 指南中用于诊断射血分数保留的心力衰竭的标准均包含在此更新的定义中。根据定义，标准治疗对于这些患者来说是不够的。正性肌力治疗可用作过渡策略，但由于缺乏结果数据，单独使用时仅是一种姑息性措施。用于立即管理心源性休克的短期机械循环支持装置和作为移植桥梁或作为目标治疗的长期机械循环支持已经取得了重大进展。心脏移植仍然是无禁忌症患者的首选治疗方法。有些患者不适合接受晚期心力衰竭治疗。对于这些通常患有多种合并症的老年人来说，应强调对晚期心力衰竭的管理，以减轻症状并提高生活质量。大多数晚期心力衰竭的治疗方法都缺乏前瞻性研究的有力证据。迫切需要开发基于证据的治疗算法，以在可能的情况下并根据患者的喜好延长生命，提高生活质量，并减轻这一弱势患者群体的住院负担。
This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.