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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION
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Content Update
MitraClip Continues to Outperform Medical Therapy Alone at 5-years, but Event Rates Remain High
The COAPT trial investigators randomized 614 patients with heart failure with left ventricular reduced ejection fraction (20-50%) on maximally tolerated guideline-directed medical therapy and symptomatic moderate-to-severe or severe secondary mitral regurgitation to either transcatheter edge-to-edge repair (TEER) with the MitraClip (Abbott) (n = 302) or medical therapy alone (n = 312). Read More
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Content Update
Effectiveness of Intravenous Iron Treatment Versus Standard Care in Patients With Heart Failure and Iron Deficiency (IRONMAN)
The IRONMAN study was a prospective, randomized trial comparing intravenous iron to usual care in patients with heart failure (HF) and reduced ejection fraction (with a history of New York Heart Association (NYHA) class II-IV symptoms) and iron deficiency (transferrin saturation <20% or serum ferritin <100µg/L). Read More
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Chapter Summary
This chapter discusses the diagnosis and treatment of heart failure with reduced ejection fraction (HFrEF), mid-range EF (HFmrEF) and recovered EF (HFrecEF), clinical syndromes that involve a complex interplay between myocardial, vascular, hemodynamic neurohormonal, and comorbid factors (see Fuster and Hurst’s Central Illustration). Early diagnosis and treatment of heart failure can improve quality of life and reduce rates of hospitalization and death. Cardinal manifestations of heart failure include dyspnea, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary, splanchnic and peripheral edema. Foundational pharmacological therapies for chronic heart failure include diuretics, beta blockers, angiotensin receptor-neprilysin inhibitors, aldosterone receptor antagonists, and sodium glucose co-transporter 2 inhibitors. Certain heart failure patients may benefit from device-based therapies such as implantable cardioverter defibrillators and cardiac resynchronization therapy. Considering the high morbidity and mortality associated with heart failure, it is essential to appropriately diagnose and employ guideline directed medical therapy.
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The syndrome of heart failure has existed since humans first began to document disease. Clinical texts attributable to Hippocrates describe patients with shortness of breath, edema, and anasarca, in a manner not too varied from contemporary accounts.1 It has also long been realized that heart failure is not caused by a single disease; rather, it is an amalgamate of several diseases that have unique etiologies, natural histories, and treatments.2 The shared feature of this cluster of illnesses is damage to the cardiac issue. Initially, the heart compensates in various manners to a loss in reserve; however, once there is a critical degree of impairment in its structure and function, a final common pathway emerges that shares similarities in symptoms and findings.
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Over the last several decades, dramatic improvements in management of valvular and ischemic heart disease have decreased mortality from these illnesses and consequently led to an increase in the incidence and prevalence of heart failure. ...