The question that arose were how would the doctor make use of these data, and would this make a difference to the treatments prescribed and via that mechanism would it affect long-term patient outcomes.Īt the time of the 2016 ESC Heart Failure Guidelines, 1 the only recommendations regarding the use of implantable haemodynamic monitoring was that of PAP monitoring using the CardioMEMS™ system, in which it was advised that the use of the CardioMEMS™ system may be considered in symptomatic patients with HF with previous HF hospitalization in order to reduce the risk of recurrent HF hospitalization (with a class IIb recommendation), and multiparameter monitoring based on implanted ICD’s with this capacity (the “IN-TIME approach” 2), in which it was advised that this may be considered in symptomatic patients with HFrEF (LVEF ≤35%) in order to improve clinical outcomes, also with a class IIb recommendation. For the first time, a possibility for a physician to obtain more frequent haemodynamic evaluation of HF patients, and the opportunity to take these data into account in their management decisions. The development of miniature implantable devices which could measure haemodynamic variables and transmit them to a monitor outside the body changed this paradigm and offered. The management of HF patients at home became more driven by symptoms and nurse evaluation or by simple monitoring techniques such as daily weight measurements to adjust diuretic doses. Haemodynamic assessment thus became less frequently used to guide most treatment decisions. ![]() With the advent of ACE inhibitors, ARB’s, beta-blockers and MRA’s modifying disease outcomes without predominantly affecting haemodynamics, this “haemodynamic” model of HF fell somewhat out of favour, and physicians began to make treatment plans based on guideline directed medical therapy recommendations, themselves largely based on applying the results of trial results, that did not involve haemodynamic monitoring of HF patients. At infrequent intervals, some invasive haemodynamic measurements could be performed at cardiac catheterization to obtain direct haemodynamic measures, and the future management plans of the patient would be significantly modified after such a haemodynamic assessment such as a transplant eligibility assessment. Doppler techniques could be used to estimate cardiac output. Later echocardiography gave another window into haemodynamic assessment offering measures of left ventricular systolic and diastolic functions and even indirectly filling pressures and pulmonary artery pressures (PAPs). Blood pressure, heart rate, jugular venous pressure and auscultation of the lungs were all ways the physician would assess the patient’s haemodynamic status, supplemented by heart rhythm assessment. For HF, this was almost entirely a haemodynamic or congestion assessment, as the only effective treatments before the 1980s were diuretics or digoxin. In historical times, the patient attended a physician for evaluation and the physician would examine the patient and made special measurements to determine the state of the patient sand what treatments were needed. ![]() ![]() Heart failure (HF) is a complex disorder with haemodynamic, neurohormonal, metabolic, functional and electrical aspects to be considered, along with the impact non-cardiovascular co-morbidities.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |