AHA 2012: Engineering Success in Heart Failure

December 2012

Successfully managing heart failure is one the looming issues for cardiovascular medicine, with prevalence expected to grow significantly over the coming decades. The plenary session “Engineering Success in Heart Failure” looked at where things are headed, from therapy to devices to delivery of care.

Now that we know that the heart does regenerate, albeit slowly—nine to 10 times in a lifetime—various types of stem cells offer intriguing possibilities for the treatment of heart failure. For recent developments, see “Stem Cells for Cardiac Repair” within our AHA coverage.

As for personalized medicine in heart failure, the panel said that today’s treatment is based on populations, not the individual. Heart failure care must take into account a variety of factors so that care can be tailored to the individual patient: response to medication, genetic profile, patient education, frailty, and whether the primary cause is related to heart disease, emotional response to disease and treatment, and whether care adhers to guidelines.

Most new drugs on the horizon represent incremental improvement rather than major gains over those currently achieved. New emphasis is being placed more on promoting the body’s own natural beneficial mechanisms than inhibiting harmful pathways. Many new compounds for the treatment of diabetes are under study because current drugs tend to have negative effects for patients with heart failure.

Among mechanical devices for supporting circulation, the emphasis is on continued miniaturization to allow less invasive implantation procedures. This will offer expanded options in the positioning of pumps and will improve the patient experience. Biocompatibility and trauma to the blood remain challenges.

The panel closed by emphasizing the critical systems-level issue of managing transitions in care to maintain optimal treatment. Aspects include home monitoring, home care, patient and family education, follow-up appointments and prescriptions at time of discharge. This is an area that the Heart Institute has excelled in with highly effective efforts that include telehome monitoring and tools and training for regional guideline adherence.

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