![Page 1: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/1.jpg)
Heart Failure TherapiesState of the Art 2017
Andrew J. Sauer, MDAssistant ProfessorDirector, Center for Heart FailureMedical Director, Heart TransplantationUNOS Primary Transplant [email protected]
![Page 2: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/2.jpg)
DisclosuresNovartis: Speaker HonorariumMedtronic: Speaker/Consultant Honorarium
10/23/17 2
![Page 3: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/3.jpg)
Learning Objectives• Understand the heart failure epidemiology trends• Review the 2017 Stage C HF Guidelines Update• Identify Stage D “Advanced” Heart Failure• Appreciate Contemporary LVAD Therapy• Recognize some temporary mechanical support
technologies in the critically ill patient
10/23/17 3
![Page 4: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/4.jpg)
Heart Failure Burden
1.JACCHF.2013;1:1-20.2. RoseEA,etal.Long-termmechanicalleftventricularassistanceforend-stageheartfailure.
NEngl JMed.Nov.2001;5;345(20):1435-43.4. Rogers,Butler,Lansman,etal.JAmColl Cardiol.2007;50:741-47.5. Hershberger,Nauman,Walker,etal.JCardFail.2003;22:616-24.6. Gorodeski,Chu,Reese,etal.Circ HeartFail.2009;2:320-24.7. Dataonfile.Pleasanton,Calif:Thoratec Corp.
![Page 5: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/5.jpg)
Heart Failure Natural History
![Page 6: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/6.jpg)
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
![Page 7: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/7.jpg)
CitationThisslidesetwasadaptedfromthe2017ACC/AHA/HFSAFocusedUpdateofthe2013ACCF/AHAGuidelinefortheManagementofHeartFailure(JournaloftheAmericanCollegeofCardiology). PublishedonApril28,2017,availableat: Yancy,et.al.ACC/AHA/HFSA2017HeartFailureFocusedUpdate
Thefull-textguidelinesarealsoavailableonthefollowingWebsites:• AmericanCollegeofCardiology(www.acc.org)• AmericanHeartAssociation(professional.heart.org)• HeartFailureSocietyofAmerica(www.hfsa.org)
![Page 8: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/8.jpg)
Stage C
Treatment of HF Stages A Through D
![Page 9: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/9.jpg)
Treatment of HFrEF Stage C and D
†Hydral-Nitratesgreenbox:ThecombinationofISDN/HYDwithARNIhasnotbeenrobustlytested.BPresponseshouldbecarefullymonitored.‡See2013HFguideline.§ParticipationininvestigationalstudiesisalsoappropriateforstageC,NYHAclassIIandIIIHF.ACEIindicatesangiotensin-convertingenzymeinhibitor;ARB,angiotensinreceptor-blocker;ARNI,angiotensinreceptor-neprilysin inhibitor;BP,bloodpressure;bpm,beatsperminute;C/I,contraindication;COR,ClassofRecommendation;CrCl,creatinineclearance;CRT-D,cardiacresynchronizationtherapy–device;Dx,diagnosis;GDMT,guideline-directedmanagementandtherapy;HF,heartfailure;HFrEF,heartfailurewithreducedejectionfraction;ICD,implantablecardioverter-defibrillator;ISDN/HYD,isosorbidedinitratehydral-nitrates;K+,potassium;LBBB,leftbundle-branchblock;LVAD,leftventricularassistdevice;LVEF,leftventricularejectionfraction;MI,myocardialinfarction;NSR,normalsinusrhythm;andNYHA,NewYorkHeartAssociation.
![Page 10: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/10.jpg)
Neprilysin Inhibition (ARNI: LCZ696)sacubatril-valsartan
![Page 11: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/11.jpg)
Simplifiedschematicoftherenin–angiotensin–aldosteronesystem.
vonLueder TGetal.Circ HeartFail.2013;6:594-605
![Page 12: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/12.jpg)
Simplifiedschematicofthenatriureticpeptidesystem(NPS).
vonLueder TGetal.Circ HeartFail.2013;6:594-605
![Page 13: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/13.jpg)
PARADIGM HF
![Page 14: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/14.jpg)
Kaplan–MeierCurvesforKeyStudyOutcomes,AccordingtoStudyGroup.
McMurray JJ et al. N Engl J Med 2014. DOI: 10.1056/NEJMoa1409077
![Page 15: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/15.jpg)
PrimaryandSecondaryOutcomes.
McMurray JJ et al. N Engl J Med 2014. DOI: 10.1056/NEJMoa1409077
![Page 16: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/16.jpg)
Pharmacological Treatment for Stage C HF With Reduced EF
Renin-Angiotensin System Inhibition With ACE-Inhibitor or ARB or ARNI
I
ACE-I:ATheclinicalstrategyofinhibitionoftherenin-angiotensinsystemwithACEinhibitors(LevelofEvidence:A), ORARBs(LevelofEvidence:A), OR ARNI(LevelofEvidence:B-R)inconjunctionwithevidence-basedbetablockers,andaldosteroneantagonistsinselectedpatients,isrecommendedforpatientswithchronicHFrEF toreducemorbidityandmortality.
NEW: Newclinicaltrialdatapromptedclarificationandimportantupdates.ARB:A
ARNI:B-R
COR LOE Recommendations Comment/Rationale
![Page 17: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/17.jpg)
Pharmacological Treatment for Stage C HF With Reduced EF
Renin-Angiotensin System Inhibition With ACE-Inhibitor or ARB or ARNI
COR LOE Recommendations Comment/Rationale
I ARNI:B-R
InpatientswithchronicsymptomaticHFrEF NYHAclassIIorIIIwhotolerateanACEinhibitororARB,replacementbyanARNIisrecommendedtofurtherreducemorbidityandmortality.
NEW:Newclinicaltrialdatanecessitatedthisrecommendation.
![Page 18: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/18.jpg)
Pharmacological Treatment for Stage C HF With Reduced EF
Renin-Angiotensin System Inhibition With ACE-Inhibitor or ARB or ARNI
COR LOE Recommendations Comment/Rationale
III:Harm B-R
ARNIshouldnotbeadministeredconcomitantlywithACE inhibitorsorwithin36hoursofthelastdoseofanACEinhibitor.
NEW:AvailableevidencedemonstratesapotentialsignalofharmforaconcomitantuseofACEinhibitorsandARNI.
III:Harm C-EO
ARNIshouldnotbeadministeredtopatientswithahistoryofangioedema.
NEW:Newclinicaltrialdata.
![Page 19: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/19.jpg)
Pharmacological Treatment for Stage C HF With Reduced EF
Ivabradine
COR LOE Recommendations Comment/Rationale
IIa B-R
IvabradinecanbebeneficialtoreduceHFhospitalizationforpatientswithsymptomatic(NYHAclassII-III)stablechronicHFrEF(LVEF≤35%)whoarereceivingGDEM*,includingabetablockeratmaximumtolerateddose,andwhoareinsinusrhythmwithaheartrateof70bpmorgreateratrest.
NEW:Newclinicaltrialdata.
*Inotherpartsofthedocument,theterm“GDMT”hasbeenusedtodenoteguideline-directedmanagementandtherapy.Inthisrecommendation,however,theterm“GDEM”hasbeenusedtodenotethissameconceptinordertoreflecttheoriginalwordingoftherecommendationthatinitiallyappearedinthe“2016ACC/AHA/HFSAFocusedUpdateonNewPharmacologicalTherapyforHeartFailure:AnUpdateofthe2013ACCF/AHAGuidelinefortheManagementofHeartFailure”.
![Page 20: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/20.jpg)
HFpEF Trends in Heart Failure
NEngl JMed2006;355:251-9.
![Page 21: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/21.jpg)
NEngl JMed2006;355:251-9.
Trends in HF
![Page 22: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/22.jpg)
Barry A. Borlaug, and Margaret M. Redfield Circulation. 2011;123:2006-2014
Response to treatment HFrEF vs HFpEF
![Page 23: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/23.jpg)
Shah,A.M.&Pfeffer,M.A.(2012) ThemanyfacesofheartfailurewithpreservedejectionfractionNat.Rev.Cardiol.doi:10.1038/nrcardio.2012.123
*ElectricalandMechanicalRepolarizationHeterogeneity
![Page 24: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/24.jpg)
Pharmacological Treatment for Stage C HF With Preserved EF
I B
SystolicanddiastolicbloodpressureshouldbecontrolledinpatientswithHFpEF inaccordancewithpublishedclinicalpracticeguidelinestopreventmorbidity
2013recommendationremainscurrent.
I C
DiureticsshouldbeusedforreliefofsymptomsduetovolumeoverloadinpatientswithHFpEF.
2013recommendationremainscurrent.
COR LOE Recommendations Comment/Rationale
![Page 25: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/25.jpg)
IIb B-R
InappropriatelyselectedpatientswithHFpEF(withEF≥45%,elevatedBNPlevelsorHFadmissionwithin1year,estimatedglomerularfiltrationrate>30mL/min, creatinine<2.5mg/dL,potassium<5.0mEq/L),aldosteronereceptorantagonistsmightbeconsideredtodecreasehospitalizations.
NEW: CurrentrecommendationreflectsnewRCTdata.
Pharmacological Treatment for Stage C HF With Preserved EF
COR LOE Recommendations Comment/Rationale
IIb B
TheuseofARBsmightbeconsideredtodecreasehospitalizationsforpatientswithHFpEF.
2013recommendationremainscurrent.
![Page 26: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/26.jpg)
Anemia
Important Comorbidities in HF
![Page 27: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/27.jpg)
Anemia
COR LOE Recommendations Comment/Rationale
IIb B-R
InpatientswithNYHAclassIIandIIIHFandirondeficiency(ferritin<100ng/mLor100to300ng/mLiftransferrinsaturationis<20%),intravenousironreplacementmightbereasonabletoimprovefunctionalstatusandQoL.
NEW: Newevidenceconsistentwiththerapeuticbenefit.
III:NoBenefit B-R
InpatientswithHFandanemia,erythropoietin-stimulatingagentsshouldnotbeusedtoimprovemorbidityandmortality.
NEW: Currentrecommendationreflectsnewevidencedemonstratingabsenceoftherapeuticbenefit.
![Page 28: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/28.jpg)
What About Heart Failure Complicated by Shock?
Who is a Stage D HF Patient?
![Page 29: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/29.jpg)
Cardiogenic Shock
![Page 30: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/30.jpg)
Intra-Aortic Balloon Pump: 2015
![Page 31: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/31.jpg)
IABP post AMI: SHOCK-II Trial
![Page 32: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/32.jpg)
Temporary Support Devices
![Page 33: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/33.jpg)
We Can’t Transplant Everybody
1. Currentestimatesofadultpatientswithadvancedheartfailure(HF)intheUnitedStates,withprojectedleftventricularassistdevice(LVAD)candidates.U.S.populationestimateisderivedfromU.S.Censusdata.EstimateofHFprevalenceisderivedfromlatestAmericanHeartAssociation(AHA)statistics.
2. UNOSWebsite:http://optn.transplant.hrsa.gov3. O’Connell.AdvancedHeartFailureTherapiesForum,Atlanta.2013.
![Page 34: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/34.jpg)
Ventricular Assist Device: State of the Art 2017
![Page 35: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/35.jpg)
MCS vs Medical Therapy
![Page 36: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/36.jpg)
MCS vs Medical Therapy
![Page 37: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/37.jpg)
Evolution of Devices
![Page 38: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/38.jpg)
10 Main Points on LVAD 20171. LVAD: The Big Picture2. LVAD: Hemodynamic Optimization3. LVAD Device Trends 2006-20164. LVAD Trial Data Summary & New Devices5. Adverse Event Rate Trends6. Quality of Life7. Cost of Device Implantation8. Cost Effectiveness9. LVAD and Electrophysiology10.The Future10/23/17 38
![Page 39: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/39.jpg)
1. LVAD: THE BIG PICTURE
![Page 40: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/40.jpg)
10/23/17 40
![Page 41: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/41.jpg)
2. LVAD: HEMODYNAMICOPTIMIZATION
![Page 42: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/42.jpg)
10/23/17 42
![Page 43: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/43.jpg)
3. LVAD IMPLANTTRENDS: 2006-2016
![Page 44: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/44.jpg)
10/23/17 44
![Page 45: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/45.jpg)
10/23/17 45
![Page 46: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/46.jpg)
4. LANDMARK TRIALS& NEW TECHNOLOGY
![Page 47: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/47.jpg)
10/23/17 47
![Page 48: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/48.jpg)
10/23/17 48
![Page 49: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/49.jpg)
5. ADVERSE EVENT RATES
![Page 50: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/50.jpg)
10/23/17 50
![Page 51: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/51.jpg)
6. QUALITY OF LIFE
![Page 52: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/52.jpg)
Quality of Life Data: INTERMACS
10/23/17 52
![Page 53: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/53.jpg)
7. COST: WHAT DRIVES COST?
![Page 54: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/54.jpg)
What Drives the VAD Implant Cost?
10/23/17 54
![Page 55: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/55.jpg)
Post Implant Length of Stay of Patients Discharged Alive
0
5
10
15
20
25
30
Days Intermacs
TUKH
10/23/17 55
![Page 56: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/56.jpg)
8. COST-EFFECTIVENESS
![Page 57: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/57.jpg)
DT LVAD: Costs, QALYs, ICER
10/23/17 57
![Page 58: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/58.jpg)
Pulsatile to CF – LVAD Transition
10/23/17 58
![Page 59: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/59.jpg)
Beyond the Index Admission: Costs
10/23/17 59
![Page 60: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/60.jpg)
9. LVAD & Electrophysiology
![Page 61: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/61.jpg)
LVAD: EP Topics• ICD Implantation Post-LVAD• Tachy-therapies settings• LV lead ON vs OFF• Atrial fibrillation treatments• VT Ablation
10/23/17 61
![Page 62: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/62.jpg)
10. THE FUTURE
![Page 63: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/63.jpg)
Future Developments & Challenges• Driveline removal (totally internal LVAD)• Minimally invasive implantation• Continuous hemodynamic monitoring
10/23/17 63
![Page 64: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/64.jpg)
10 Main Points on LVAD 20171. Heart failure epidemic: large and growing2. Novel pharma and device therapies
-ARNI to replace ARB/ACE-I-HCN blockers-ambulatory PA pressure monitoring devices
3. Lacking data / guidelines on HFpEF4. System innovations are key5. Refer early for Stage D HF patients
10/23/17 64
![Page 65: Heart Failure Therapies State of the Art 2017...Heart Failure (Journal of the American College of Cardiology).Published on April 28, 2017, available at:Yancy, et. al. ACC/AHA/HFSA](https://reader036.vdocument.in/reader036/viewer/2022071106/5fe0020e7b69e462560f1638/html5/thumbnails/65.jpg)
Andrew J. Sauer, MDAssistant ProfessorDirector, Center for Heart FailureMedical Director, Heart TransplantationUNOS Primary Transplant [email protected]