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Traditional Treatments

Traditionally, heart failure is treated by drugs (medical management), pacemakers (cardiac resynchronization therapy) or heart transplants.

Medical management slows disease progression in its early stages but with little improvement in long term mortality9 Herscheberger RE, Nauman D, Walker TL, et al: Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory end stage heart failure. J Card Failure 2003;9:180-187,10 Bristow MR, Saxon LA, Boehmer J et al. Cardiac resynchronisation therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350:2140-2150. Once patients progress to advanced heart failure, it is nearly always terminal if only managed medically: in Hersheberger’s study, half of the patients had died within 6 months, only 6% were alive at 1 year, and all were dead by 26 months.  In the REMATCH study, only 8% of patients in the medically treated group were alive at 2 years11 Rose E, Gelijns A, Moskowitz A et al: Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001; 345(20): 1435 – 1443.

Cardiac resynchronisation, as with medical therapy, has been demonstrated not to be an effective long term treatment for advanced heart failure. Although there are benefits in the early stages of heart failure, when patients reach advanced heart failure mortality and quality of life are not significantly improved12 Cleland JGF, Daubert J, Erdmann E et al: The effect of cardiac resynchronisation on morbidity and mortality in heart failure. N Engl J Med 2005; 352:1539-1549.

Heart transplantation was the benchmark for increased longevity and symptomatic relief for advanced heart failure, however, with 97 heart transplants carried out in the UK in 201113 British Heart Foundation. http://www.bhf.org.uk/heart-health/treatment/heart-transplant.aspx and about 2000 in the US14 HRSA Organ Procurement and Transplantation Network transplantation is severely limited by availability.

Other approaches, such as devices that reduce the size of the heart and cell based therapies, are either in the early stages of development or are not achieving desired outcomes.

 

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VAD therapy

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