Heart failure management – A multidisciplinary approach: Literature review and single center experience
Main Article Content
Abstract
Introduction: Heart failure is a severe chronic disease affecting millions of people worldwide, decreasing their quality of life and having a high burden of mortality. The treatment of the heart failure evolved in a spectacular way in the last years with the development of the new medical therapies, interventions and devices. Unfortunately, outcomes remain poor and need proper implementation of the current knowledge. A multidisciplinary team approach is considered the best way to deliver care for heart failure patients.
Objective: To make a short review of recent data provided by the trials and to describe why the multidisciplinary team approach is necessary during heart failure care. To describe how is the heart failure management performed in our center.
Literature review and our center experience: We analyzed the European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure, made a literature search in Pubmed database and selected the most important articles related to the heart failure management, giving special attention to the evidence provided by the clinical trials.
We describe how we implemented the recommendation and multidisciplinary team approach in Medpark International Hospital, Chisinau, Republic of Moldova.
There are pharmacological management and a non-pharmacological management available. Non-pharmacological management of the heart failure includes cardiac surgery, interventional cardiology, electrophysiology, sleep-disordered breathing treatment, physical therapy, patient education, etc. Many cases of HF patients need a Heart Team approach that includes a cardiac surgeon, an interventional cardiologist, an electrophysiologist and a general cardiologist. We implemented the multidisciplinary approach providing better care for our patients.
Conclusions: The care of heart failure is multidisciplinary and needs some super-specialized team members.
A multidisciplinary team approach is considered the best way to deliver care for HF patients. There are lot of tricky situations when a decision made without the team support could be a wrong decision. To avoid such situations is important to implement the MDT approach and to continually educate the team members, keeping the pace with the HF management updates.
Keywords:
Cardiac surgeon, cardiologist, electrophysiologist, interventional cardiologist, heart failure, Heart Team, multidisciplinary team, optimal medical treatment
Article Details
How to Cite
DARCIUC, Radu et al.
Heart failure management – A multidisciplinary approach: Literature review and single center experience.
Medical Research Archives, [S.l.], v. 12, n. 11, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5918>. Date accessed: 12 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i11.5918.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart. 2022;108(17):1351-1360. Published 2022 Aug 11. Doi:10.1136/heartjnl-2021-320131
3. Authors/Task Force Members:, McDonagh TA, Metra M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24(1):4-131. Doi:10.1002/ejhf.2333
4. Authors/Task Force Members:, McDonagh TA, Metra M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2024;26(1):5-17. Doi:10.1002/ejhf.3024
5. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999;353:2001-2007.
6. Hjalmarson A, Goldstein S, Fagerberg B, et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA. 2000;283(10):1295-1302. Doi:10.1001/jama.283.10.1295
7. Packer M, Fowler MB, Roecker EB, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation. 2002;106(17):2194-2199. Doi:10.1161/01.cir.0000035653.72855.bf
8. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999;353:9-13.
9. Flather MD, Shibata MC, Coats AJ, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26(3):215-225. Doi:10.1093/eurheartj/ehi115
10. The CONSENSUS Trial Study Group. Enalapril for congestive heart failure. N Engl J Med. 1987;317(21):1349-1351. Doi:10.1056/NEJM198711193172112
11. SOLVD Investigators, Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325(5):293-302. Doi:10.1056/NEJM199108013250501
12. Packer M, Poole-Wilson PA, Armstrong PW, et al. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation. 1999;100(23):2312-2318. Doi:10.1161/01.cir.100.23.2312.
13. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709-717. Doi:10.1056/NEJM199909023411001
14. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21. Doi:10.1056/NEJMoa1009492
15. McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003;362(9386):767-771. Doi:10.1016/S0140-6736(03)14283-3
16. Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003;362(9386):772-776. Doi:10.1016/S0140-6736(03)14284-5
17. Cohn JN, Tognoni G; Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med. 2001;345(23):1667-1675. Doi:10.1056/NEJMoa010713
18. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993-1004. Doi:10.1056/NEJMoa1409077
19. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-1424. Doi:10.1056/NEJMoa2022190
20. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. Doi:10.1056/NEJMoa1911303
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