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  • Review Article
  • Published:

Devices in the management of advanced, chronic heart failure

Nature Reviews Cardiology volume 10, pages 98–110 (2013)Cite this article

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Abstract

Heart failure (HF) is a global phenomenon, and the overall incidence and prevalence of the condition are steadily increasing. Medical therapies have proven efficacious, but only a small number of pharmacological options are in development. When patients cease to respond adequately to optimal medical therapy, cardiac resynchronization therapy has been shown to improve symptoms, reduce hospitalizations, promote reverse remodelling, and decrease mortality. However, challenges remain in identifying the ideal recipients for this therapy. The field of mechanical circulatory support has seen immense growth since the early 2000s, and left ventricular assist devices (LVADs) have transitioned over the past decade from large, pulsatile devices to smaller, more-compact, continuous-flow devices. Infections and haematological issues are still important areas that need to be addressed. Whereas LVADs were once approved only for 'bridge to transplantation', these devices are now used as destination therapy for critically ill patients with HF, allowing these individuals to return to the community. A host of novel strategies, including cardiac contractility modulation, implantable haemodynamic-monitoring devices, and phrenic and vagus nerve stimulation, are under investigation and might have an impact on the future care of patients with chronic HF.

Key Points

  • Cardiac resynchronization therapy (CRT) has evolved as an effective therapy for many patients with chronic heart failure, especially those with left bundle branch block

  • CRT device optimization remains challenging, and is an area of intense investigation

  • Left ventricular assist devices can serve as a bridge to cardiac transplantation or destination therapy for critically ill patients with heart failure, and the use of the latest devices has increased patient survival

  • Physicians must be aware of various complex issues, including haematological and infectious concerns, when treating patients with chronic heart failure

  • Several novel, investigational devices for chronic heart failure are on the horizon and hold substantial promise to improve patient outcomes

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Figure 1: CRT lead placement.
Figure 2: Designs of LVADs.
Figure 3: The positioning of the HVAD® pump (HeartWare, Inc., Miami Lakes, FL, USA) within the pericardial space.

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  1. Division of Cardiovascular Medicine, The Ohio State University, 473 West 12th Avenue, Room 110P, Columbus, 43210-1252, OH, USA

    William T. Abraham & Sakima A. Smith

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S. A. Smith researched data for the article. Both authors discussed its content, wrote the article, and reviewed and edited the manuscript before submission.

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W. T. Abraham is or has been a consultant for the following companies: Biotronik, Medtronic, and St Jude Medical. S. A. Smith declares no competing interests.

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Abraham, W., Smith, S. Devices in the management of advanced, chronic heart failure. Nat Rev Cardiol 10, 98–110 (2013). https://doi.org/10.1038/nrcardio.2012.178

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