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Diagnosis and management of heart failure from hospital admission to discharge: A practical expert guidance
- Source :
- Annales de cardiologie et d'angeiologie. 71(1)
- Publication Year :
- 2021
-
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.
- Subjects :
- Heart Failure
education.field_of_study
medicine.medical_specialty
business.industry
Defibrillation
medicine.medical_treatment
MitraClip
Aminobutyrates
Population
Management of heart failure
Biphenyl Compounds
Cardiomyopathy
medicine.disease
Comorbidity
Hospitals
Patient Discharge
Hospitalization
Cardiac amyloidosis
Heart failure
Medicine
Humans
Cardiology and Cardiovascular Medicine
business
education
Intensive care medicine
Subjects
Details
- ISSN :
- 17683181
- Volume :
- 71
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Annales de cardiologie et d'angeiologie
- Accession number :
- edsair.doi.dedup.....ff2610d46bd6783a38aaada27e6cd7d4