Diagnosis and management of heart failure from hospital admission to discharge: A practical expert guidance.
Ann Cardiol Angeiol (Paris)
; 71(1): 41-52, 2022 Feb.
Article
em En
| MEDLINE
| ID: mdl-34274113
ABSTRACT
Heart failure (HF) has high event rates, mortality, and is challenging to manage in clinical practice. Clinical management is complicated by complex therapeutic strategies in a population with a high prevalence of comorbidity and general frailty. In the last four years, an abundance of research has become available to support multidisciplinary management of heart failure from within the hospital through to discharge and primary care as well as supporting diagnosis and comorbidity management. Within the hospital setting, recent evidence supports sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40%. Furthermore, new strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF. Studies with tafamidis report major clinical benefits specifically for patients with ATTR cardiac amyloidosis, a remaining underdiagnosed and undertreated disease. New evidence for medical interventions supports his bundle pacing to reduce QRS width and improve haemodynamics as well as ICD defibrillation for non-ischemic cardiomyopathy. The Mitraclip reduces hospitalisations and mortality in patients with symptomatic, secondary mitral regurgitation and ablation reduces mortality and hospitalisations in patients with paroxysmal and persistent atrial fibrillation. In end-stage HF, the 2018 French Heart Allocation policy should improve access to heart transplants for stable, ambulatory patients and, mechanical circulatory support should be considered to avoid deteriorating on the waiting list. In the community, new evidence supports that improving discharge education, treatment and patient support improves outcomes. The authors believe that this review fills the gap between the guidelines and clinical practice and provides practical recommendations to improve HF management.
Palavras-chave
Acute heart failure; Approche multidisciplinaire; Comorbidities; Comorbidités; Discharge; Guide pratique; Heart failure; Heart failure management; Insuffisance cardiaque; Insuffisance cardiaque aiguë; Multidisciplinary approach; Optimisation du traitement; Parcours patient; Pathway; Practical guide; Prise en charge de l'insuffisance cardiaque; Treatment optimization; Écoulement
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Alta do Paciente
/
Insuficiência Cardíaca
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Ann Cardiol Angeiol (Paris)
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
França