Congestive heart failure treatment of patients with refractory end-stage heart failure (Stage D)

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Congestive Heart Failure Microchapters

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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF
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Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
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Congestive heart failure end-of-life considerations

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]Mahmoud Sakr, M.D. [3]

2013 ACCF/AHA Guideline/2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2]

Patients with Refractory End-Stage Heart Failure (Stage D) (DO NOT EDIT) [1][2][3]

Class I
"1. Fluid restriction (1.5 to 2 L/d) is reasonable in stage D, especially in patients with hyponatremia, to reduce congestive symptoms. (Level of Evidence: C) "
"2. Meticulous identification and control of fluid retention is recommended in patients with refractory endstage HF. [4][5][6][7][8][9][10][11] (Level of Evidence: B) "
"3. Until definitive therapy (e.g., coronary revascularization, mechanical circulatory support, heart transplantation) or resolution of the acute precipitating problem, patients with cardiogenic shock should receive temporary intravenous inotropic support to maintain systemic perfusion and preserve end-organ performance. (Level of Evidence: C) "
"4. Referral for cardiac transplantation in potentially eligible patients is recommended for patients with refractory end-stage HF.[12] [13] (Level of Evidence: C)"
"5. Referral of patients with refractory end-stage HF to a HF program with expertise in the management of refractory HF is useful. [14][15][16][17] (Level of Evidence: A) "
"6. 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) "
"7. Patients with refractory end-stage HF and implantable defibrillators should receive information about the option to inactivate defibrillation. (Level of Evidence: C) "
Class III (No Benefit)
"1. 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. [18][19] (Level of Evidence: A) "
Class IIa
"1.Continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage D refractory to GDMT and device therapy who are eligible for and awaiting mechanical circulatory support or cardiac transplantation.[20][21](Level of Evidence: B) "
"2. MCS is beneficial in carefully selected patients with stage D HFrEF in whom definitive management (e.g., cardiac transplantation) or cardiac recovery is anticipated or planned.[22][23] (Level of Evidence: B) "
"3. Nondurable MCS, including the use of percutaneous and extracorporeal ventricular assist devices (VADs), is reasonable as a “bridge to recovery” or “bridge to decision” for carefully selected patients with HFrEF with acute, profound hemodynamic compromise.[24] [25][26] (Level of Evidence: B) "
"4. Durable MCS is reasonable to prolong survival for carefully selected* patients with stage D HFrEF. [25][27](Level of Evidence: B) "
Class IIb
"1. Short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserveend-organ performance.[28][29][30](Level of Evidence: B) "
"2. Continuous intravenous infusion of a positive inotropic agent may be considered for palliation of symptoms in patients with refractory end-stage HF.[31][32] [33][34](Level of Evidence: B) "
"3. Pulmonary artery catheter placement may be reasonable to guide therapy in patients with refractory end-stage HF and persistently severe symptoms. [13][35] (Level of Evidence: C) "
"4. The effectiveness of mitral valve repair or replacement is not established for severe secondary mitral regurgitation in refractory end-stage HF. [36][37][38] (Level of Evidence: C) "

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References

  1. ↑ 1.0 1.1 1.2 Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  2. ↑ 2.0 2.1 2.2 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
  3. ↑ 3.0 3.1 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
  4. ↑ Brater DC, Chennavasin P, Seiwell R (1980). "Furosemide in patients with heart failure: shift in dose-response curves". Clinical Pharmacology and Therapeutics. 28 (2): 182–6. PMID 7398185. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. ↑ Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P (1996). "Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion". Journal of the American College of Cardiology. 28 (2): 376–82. doi:10.1016/0735-1097(96)00161-1. PMID 8800113. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  6. ↑ Cotter G, Weissgarten J, Metzkor E, Moshkovitz Y, Litinski I, Tavori U, Perry C, Zaidenstein R, Golik A (1997). "Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure". Clinical Pharmacology and Therapeutics. 62 (2): 187–93. doi:10.1016/S0009-9236(97)90067-9. PMID 9284855. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  7. ↑ Faris R, Flather MD, Purcell H, Poole-Wilson PA, Coats AJ (2006). "Diuretics for heart failure". Cochrane Database of Systematic Reviews (Online) (1): CD003838. doi:10.1002/14651858.CD003838.pub2. PMID 16437464. Retrieved 2012-04-06.
  8. ↑ Costanzo MR, Saltzberg M, O'Sullivan J, Sobotka P (2005). "Early ultrafiltration in patients with decompensated heart failure and diuretic resistance". Journal of the American College of Cardiology. 46 (11): 2047–51. doi:10.1016/j.jacc.2005.05.099. PMID 16325040. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  9. ↑ Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E (2003). "Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD)". Journal of the American College of Cardiology. 42 (4): 705–8. PMID 12932605. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  10. ↑ Cicoira M, Zanolla L, Rossi A, Golia G, Franceschini L, Brighetti G, Marino P, Zardini P (2002). "Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure". Journal of the American College of Cardiology. 40 (2): 304–10. PMID 12106936. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  11. ↑ Faris R, Flather M, Purcell H, Henein M, Poole-Wilson P, Coats A (2002). "Current evidence supporting the role of diuretics in heart failure: a meta analysis of randomised controlled trials". International Journal of Cardiology. 82 (2): 149–58. PMID 11853901. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  12. ↑ Mehra MR, Kobashigawa J, Starling R, Russell S, Uber PA, Parameshwar J; et al. (2006). "Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006". J Heart Lung Transplant. 25 (9): 1024–42. doi:10.1016/j.healun.2006.06.008. PMID 16962464.
  13. ↑ 13.0 13.1 Jessup M, Banner N, Brozena S, Campana C, Costard-Jäckle A, Dengler T, Hunt S, Metra M, Rahmel A, Renlund D, Ross H, Warner Stevenson L (2006). "Optimal pharmacologic and non-pharmacologic management of cardiac transplant candidates: approaches to be considered prior to transplant evaluation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006". The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation. 25 (9): 1003–23. doi:10.1016/j.healun.2006.06.007. PMID 16962463. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  14. ↑ McAlister FA, Lawson FM, Teo KK, Armstrong PW (2001). "A systematic review of randomized trials of disease management programs in heart failure". The American Journal of Medicine. 110 (5): 378–84. PMID 11286953. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  15. ↑ Whellan DJ, Hasselblad V, Peterson E, O'Connor CM, Schulman KA (2005). "Metaanalysis and review of heart failure disease management randomized controlled clinical trials". American Heart Journal. 149 (4): 722–9. doi:10.1016/j.ahj.2004.09.023. PMID 15990759. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  16. ↑ Yancy CW, Krum H, Massie BM, Silver MA, Stevenson LW, Cheng M, Kim SS, Evans R (2007). "The Second Follow-up Serial Infusions of Nesiritide (FUSION II) trial for advanced heart failure: study rationale and design". American Heart Journal. 153 (4): 478–84. doi:10.1016/j.ahj.2007.02.004. PMID 17383282. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  17. ↑ Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S (2007). "Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis". BMJ (Clinical Research Ed.). 334 (7600): 942. doi:10.1136/bmj.39156.536968.55. PMC 1865411. PMID 17426062. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  18. ↑ 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
  19. ↑ 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
  20. ↑ Aranda JM, Schofield RS, Pauly DF, Cleeton TS, Walker TC, Monroe VS; et al. (2003). "Comparison of dobutamine versus milrinone therapy in hospitalized patients awaiting cardiac transplantation: a prospective, randomized trial". Am Heart J. 145 (2): 324–9. doi:10.1067/mhj.2003.50. PMID 12595851.
  21. ↑ Brozena SC, Twomey C, Goldberg LR, Desai SS, Drachman B, Kao A; et al. (2004). "A prospective study of continuous intravenous milrinone therapy for status IB patients awaiting heart transplant at home". J Heart Lung Transplant. 23 (9): 1082–6. doi:10.1016/j.healun.2003.08.017. PMID 15454175.
  22. ↑ Pagani FD, Miller LW, Russell SD, Aaronson KD, John R, Boyle AJ; et al. (2009). "Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device". J Am Coll Cardiol. 54 (4): 312–21. doi:10.1016/j.jacc.2009.03.055. PMID 19608028.
  23. ↑ Grady KL, Meyer PM, Dressler D, Mattea A, Chillcott S, Loo A; et al. (2004). "Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation". Ann Thorac Surg. 77 (4): 1321–7. doi:10.1016/j.athoracsur.2003.09.089. PMID 15063260.
  24. ↑ Thiele H, Sick P, Boudriot E, Diederich KW, Hambrecht R, Niebauer J; et al. (2005). "Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock". Eur Heart J. 26 (13): 1276–83. doi:10.1093/eurheartj/ehi161. PMID 15734771.
  25. ↑ 25.0 25.1 Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, Desvigne-Nickens P, Oz MC, Poirier VL (2001). "Long-term use of a left ventricular assist device for end-stage heart failure". The New England Journal of Medicine. 345 (20): 1435–43. doi:10.1056/NEJMoa012175. PMID 11794191. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  26. ↑ Lietz K, Long JW, Kfoury AG, Slaughter MS, Silver MA, Milano CA, Rogers JG, Naka Y, Mancini D, Miller LW (2007). "Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection". Circulation. 116 (5): 497–505. doi:10.1161/CIRCULATIONAHA.107.691972. PMID 17638928. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  27. ↑ Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D; et al. (2009). "Advanced heart failure treated with continuous-flow left ventricular assist device". N Engl J Med. 361 (23): 2241–51. doi:10.1056/NEJMoa0909938. PMID 19920051.
  28. ↑ Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH; et al. (2005). "In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE)". J Am Coll Cardiol. 46 (1): 57–64. doi:10.1016/j.jacc.2005.03.051. PMID 15992636.
  29. ↑ Cuffe MS, Califf RM, Adams KF, Benza R, Bourge R, Colucci WS; et al. (2002). "Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial". JAMA. 287 (12): 1541–7. PMID 11911756.
  30. ↑ Elkayam U, Tasissa G, Binanay C, Stevenson LW, Gheorghiade M, Warnica JW; et al. (2007). "Use and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure". Am Heart J. 153 (1): 98–104. doi:10.1016/j.ahj.2006.09.005. PMID 17174645.
  31. ↑ O'Connor CM, Gattis WA, Uretsky BF, Adams KF, McNulty SE, Grossman SH; et al. (1999). "Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST)". Am Heart J. 138 (1 Pt 1): 78–86. PMID 10385768.
  32. ↑ Gorodeski EZ, Chu EC, Reese JR, Shishehbor MH, Hsich E, Starling RC (2009). "Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure". Circ Heart Fail. 2 (4): 320–4. doi:10.1161/CIRCHEARTFAILURE.108.839076. PMID 19808355.
  33. ↑ Sindone AP, Keogh AM, Macdonald PS, McCosker CJ, Kaan AF (1997). "Continuous home ambulatory intravenous inotropic drug therapy in severe heart failure: safety and cost efficacy". American Heart Journal. 134 (5 Pt 1): 889–900. PMID 9398101. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  34. ↑ Miller LW, Merkle EJ, Herrmann V (1990). "Outpatient dobutamine for end-stage congestive heart failure". Critical Care Medicine. 18 (1 Pt 2): S30–3. PMID 2293976. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  35. ↑ Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, Wagner D, Desbiens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA (1996). "The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators". JAMA : the Journal of the American Medical Association. 276 (11): 889–97. PMID 8782638. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  36. ↑ Bolling SF, Pagani FD, Deeb GM, Bach DS (1998). "Intermediate-term outcome of mitral reconstruction in cardiomyopathy". The Journal of Thoracic and Cardiovascular Surgery. 115 (2): 381–6, discussion 387–8. PMID 9475533. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  37. ↑ Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM (2005). "Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction". Journal of the American College of Cardiology. 45 (3): 381–7. doi:10.1016/j.jacc.2004.09.073. PMID 15680716. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  38. ↑ Mann DL, Acker MA, Jessup M, Sabbah HN, Starling RC, Kubo SH (2007). "Clinical evaluation of the CorCap Cardiac Support Device in patients with dilated cardiomyopathy". The Annals of Thoracic Surgery. 84 (4): 1226–35. doi:10.1016/j.athoracsur.2007.03.095. PMID 17888974. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)

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