New consensus statement outlines benefits, challenges of device-based therapies for HF
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Key takeaways:
- Medical therapy helps many patients with heart failure, but some also need device therapy.
- A new consensus statement outlines which patients could benefit from HF device therapy, and offers management tips.
A new consensus statement from the Heart Failure Society of America outlines how device-based therapies can help certain patients with HF and how HF devices can be integrated into clinical workflow.
“While there have been improvements in using medications or pills to treat patients with heart failure, unfortunately there is still significant morbidity and mortality in many patients,” Jerry D. Estep, MD, division chair of cardiovascular medicine at Cleveland Clinic Florida and co-lead author of the statement, told Healio. “And so there are gaps that we hope to close, and device use and consideration in selected patients can help.”
The devices discussed in the statement include cardiac contractility modulation (Optimizer Smart System, Impulse Dynamics), baroreflex activation therapy (Barostim, CVRx), valve interventions with transcatheter aortic valve replacement, mitral valve edge-to-edge repair, tricuspid repair, pulmonary artery pressure monitoring (CardioMEMS, Abbott) and a left ventricular assist device (HeartMate 3, Abbott).
‘Our daily bread and butter’
A statement was needed because “device-based interventions in heart failure is our daily bread and butter. We use some form of devices almost as frequently as we use pharmacological interventions,” Marat Fudim, MD, MHS, associate professor of medicine at Duke University School of Medicine, member in the Duke Clinical Research Institute and co-lead author of the statement, told Healio. “Their development is much faster-paced than pharmacological development. Training is lagging a little bit behind on device-based interventions, both for monitoring and for therapy.”
A key message of the statement is to “think of devices early, and as a complementary strategy,” Fudim said in an interview. “There is a breadth of them. We often think of device-based therapies only when traditional approaches have failed,” which may be due to devices having much less premarket testing than drugs.
The statement encourages clinicians to diagnose and phenotype patients early, stratify them for risk properly and take a personalized approach to combining pharmacological and device therapies.
Timing of device therapy
“Timing remains critical on when to consider device therapy, and I think as devices in general become more forgiving in terms of less side effects, and are examined in terms of improving outcome, I think we will see earlier consideration of device therapy to alter the trajectory of heart failure in selected patients,” Estep said. “At the current time, exactly when to implement a device with ongoing escalation of medical therapy remains an unknown. Having said that, patients intolerable to appropriate escalation of medical therapy represent a high-risk group. Certainly, device therapy should be considered. I look forward to that gap closing with ongoing research.”
The statement also calls for an integrated, multidisciplinary approach to treatment, as doctors from different subspecialties may need to be involved.
“Drug-based therapy is easy: It’s the doctor, you and the pharmacist,” Fudim said. “For device-based therapies, it’s a lot more complex. There is usually a multitude of providers involved. Sometimes one prescribes, one implants, one manages. Device-based clinics are emphasizing the multidisciplinary nature of device-based care, as does this scientific statement.”
For more information:
Jerry D. Estep, MD, can be reached at estepj@ccf.org; X (Twitter): @jerryestepmd.
Marat Fudim, MD, MHS, can be reached at marat.fudim@duke.edu; X (Twitter): @fudimmarat.
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