Congestive heart failure treatment of patients with refractory end-stage heart failure (Stage D): Difference between revisions
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{{Congestive heart failure}} | {{Congestive heart failure}} | ||
{{CMG}} | {{CMG}}; {{AOEIC}} {{LG}} | ||
==Overview== | ==Overview== | ||
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{{cquote| | {{cquote| | ||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ||
'''1.''' Meticulous identification and control of fluid retention is recommended in patients with [[refractory endstage HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | '''1.''' Meticulous identification and control of fluid retention is recommended in patients with [[refractory endstage HF]]. (209-216) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
'''2.''' Referral for [[cardiac transplantation]] in potentially eligible patients is recommended for patients with [[refractory end-stage HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | '''2.''' Referral for [[cardiac transplantation]] in potentially eligible patients is recommended for patients with [[refractory end-stage HF]]. (217) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
'''3.''' Referral of patients with [[refractory end-stage HF]] to an [[HF]] program with expertise in the management of [[refractory HF]] is useful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | '''3.''' Referral of patients with [[refractory end-stage HF]] to an [[HF]] program with expertise in the management of [[refractory HF]] is useful. (218-221) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
'''4.''' Options for end-of-life care should be discussed with the patient and family when severe symptoms in patients with [[refractory end-stage HF]] persist despite application of all recommended therapies. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | '''4.''' Options for end-of-life care should be discussed with the patient and family when severe symptoms in patients with [[refractory end-stage HF]] persist despite application of all recommended therapies. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
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===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | ||
'''1.''' Consideration of an [[LV assist device]] as permanent or “destination” therapy is reasonable in highly selected patients with [[refractory end-stage HF]] and an estimated 1-year mortality over 50% with medical therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | '''1.''' Consideration of an [[LV assist device]] as permanent or “destination” therapy is reasonable in highly selected patients with [[refractory end-stage HF]] and an estimated 1-year mortality over 50% with medical therapy. (222,223) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | ||
'''1.''' [[Pulmonary artery]] catheter placement may be reasonable to guide therapy in patients with [[refractory end-stage HF]] and persistently severe symptoms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | '''1.''' [[Pulmonary artery]] catheter placement may be reasonable to guide therapy in patients with [[refractory end-stage HF]] and persistently severe symptoms. (217,224) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
'''2.''' The effectiveness of [[mitral valve repair]] or [[mitral valve replacement|replacement]] is not established for severe secondary [[mitral regurgitation]] in [[refractory end-stage HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | '''2.''' The effectiveness of [[mitral valve repair]] or [[mitral valve replacement|replacement]] is not established for severe secondary [[mitral regurgitation]] in [[refractory end-stage HF]]. (225-227) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
'''3.''' Continuous intravenous infusion of a positive [[inotropic agent]] may be considered for palliation of symptoms in patients with [[refractory end-stage HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | '''3.''' Continuous intravenous infusion of a positive [[inotropic agent]] may be considered for palliation of symptoms in patients with [[refractory end-stage HF]]. (228,229) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]=== | ||
'''1.''' Partial left ventriculectomy is not recommended in patients with non [[ischemic cardiomyopathy]] and [[refractory end-stage HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | '''1.''' Partial left ventriculectomy is not recommended in patients with non [[ischemic cardiomyopathy]] and [[refractory end-stage HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
'''2.''' Routine intermittent infusions of vasoactive and positive inotropic agents are not recommended for patients with [[refractory end-stage HF]].<ref name="pmid3766379">Krell MJ, Kline EM, Bates ER, Hodgson JM, Dilworth LR, Laufer N et al. (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3766379 Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure.] ''Am Heart J'' 112 (4):787-91. PMID: [http://pubmed.gov/3766379 3766379]</ref><ref name="pmid10426835">Oliva F, Latini R, Politi A, Staszewsky L, Maggioni AP, Nicolis E et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10426835 Intermittent 6-month low-dose dobutamine infusion in severe heart failure: DICE multicenter trial.] ''Am Heart J'' 138 (2 Pt 1):247-53. PMID: [http://pubmed.gov/10426835 10426835]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}} | '''2.''' Routine intermittent infusions of vasoactive and positive inotropic agents are not recommended for patients with [[refractory end-stage HF]]. (230,231) <ref name="pmid3766379">Krell MJ, Kline EM, Bates ER, Hodgson JM, Dilworth LR, Laufer N et al. (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3766379 Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure.] ''Am Heart J'' 112 (4):787-91. PMID: [http://pubmed.gov/3766379 3766379]</ref><ref name="pmid10426835">Oliva F, Latini R, Politi A, Staszewsky L, Maggioni AP, Nicolis E et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10426835 Intermittent 6-month low-dose dobutamine infusion in severe heart failure: DICE multicenter trial.] ''Am Heart J'' 138 (2 Pt 1):247-53. PMID: [http://pubmed.gov/10426835 10426835]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}} | ||
==Vote on and Suggest Revisions to the Current Guidelines== | ==Vote on and Suggest Revisions to the Current Guidelines== |
Revision as of 14:35, 6 April 2012
Heart failure | |
ICD-10 | I50.0 |
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ICD-9 | 428.0 |
DiseasesDB | 16209 |
MedlinePlus | 000158 |
MeSH | D006333 |
Congestive Heart Failure Microchapters |
Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
Diagnosis |
Treatment |
Medical Therapy: |
Surgical Therapy: |
ACC/AHA Guideline Recommendations
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Specific Groups: |
Congestive heart failure treatment of patients with refractory end-stage heart failure (Stage D) On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
ACC/AHA Guidelines- Treatment of Patients with Refractory End-Stage Heart Failure (Stage D) (DO NOT EDIT) [1][2]
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Class I1. Meticulous identification and control of fluid retention is recommended in patients with refractory endstage HF. (209-216) (Level of Evidence: B) 2. Referral for cardiac transplantation in potentially eligible patients is recommended for patients with refractory end-stage HF. (217) (Level of Evidence: B) 3. Referral of patients with refractory end-stage HF to an HF program with expertise in the management of refractory HF is useful. (218-221) (Level of Evidence: A) 4. Options for end-of-life care should be discussed with the patient and family when severe symptoms in patients with refractory end-stage HF persist despite application of all recommended therapies. (Level of Evidence: C) 5. Patients with refractory end-stage HF and implantable defibrillators should receive information about the option to inactivate defibrillation. (Level of Evidence: C) Class IIa1. Consideration of an LV assist device as permanent or “destination” therapy is reasonable in highly selected patients with refractory end-stage HF and an estimated 1-year mortality over 50% with medical therapy. (222,223) (Level of Evidence: B) Class IIb1. Pulmonary artery catheter placement may be reasonable to guide therapy in patients with refractory end-stage HF and persistently severe symptoms. (217,224) (Level of Evidence: C) 2. The effectiveness of mitral valve repair or replacement is not established for severe secondary mitral regurgitation in refractory end-stage HF. (225-227) (Level of Evidence: C) 3. Continuous intravenous infusion of a positive inotropic agent may be considered for palliation of symptoms in patients with refractory end-stage HF. (228,229) (Level of Evidence: C) Class III1. Partial left ventriculectomy is not recommended in patients with non ischemic cardiomyopathy and refractory end-stage HF. (Level of Evidence: C) 2. Routine intermittent infusions of vasoactive and positive inotropic agents are not recommended for patients with refractory end-stage HF. (230,231) [3][4] (Level of Evidence: A) |
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Vote on and Suggest Revisions to the Current Guidelines
Guidelines Resources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [1]
- 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation [2]
References
- ↑ 1.0 1.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112 (12):e154-235. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202
- ↑ 2.0 2.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
- ↑ Krell MJ, Kline EM, Bates ER, Hodgson JM, Dilworth LR, Laufer N et al. (1986) Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure. Am Heart J 112 (4):787-91. PMID: 3766379
- ↑ Oliva F, Latini R, Politi A, Staszewsky L, Maggioni AP, Nicolis E et al. (1999) Intermittent 6-month low-dose dobutamine infusion in severe heart failure: DICE multicenter trial. Am Heart J 138 (2 Pt 1):247-53. PMID: 10426835