Heart Failure Seminar: Focus on Assessment of HF Patients for Advanced HF Therapies (OnDemand)-Focus on Assessment

Video Transcription

Video Summary

The HPSA Heart Failure Seminar focused on assessing patients for advanced heart failure therapies, featuring experts Dr. Melissa Lyle, Joy Coles, and Dr. Jordan Hoffman. Advanced heart failure (stage D) is characterized by severe symptoms, frequent hospitalizations, and poor response or intolerance to guideline-directed medical therapy (GDMT). Early referral to specialized heart failure centers is critical to optimize outcomes and prevent irreversible organ damage, with triggers including worsening symptoms, recurrent hospitalizations, need for inotropes, low ejection fraction, and intolerance to GDMT.<br /><br />Dr. Lyle emphasized the definitions of advanced heart failure from major guidelines, risk stratification tools, and therapy options including LVAD (left ventricular assist device) and heart transplantation. She highlighted contraindications such as severe pulmonary hypertension, active malignancy, and advanced organ dysfunction, noting median survival without intervention is less than two years.<br /><br />Joy Coles detailed the comprehensive, multidisciplinary evaluation process for advanced therapies, incorporating laboratory testing, psychosocial assessment, and coordination among advanced heart failure clinicians, surgeons, pharmacists, social workers, and palliative care. The I NEED HELP acronym (Inotropes, NYHA class, End-organ dysfunction, Defibrillator shocks, Escalating diuretics, Low blood pressure, and intolerance to therapy) guides referral timing. Social determinants of health, health literacy, and caregiver support are pivotal for candidacy.<br /><br />Dr. Hoffman reviewed surgical perspectives on transplantation, donor-recipient matching (favoring predicted heart mass ratio), and perioperative challenges. He advocated flexibility in candidate selection, prioritizing a “get to yes” approach despite comorbidities, noting age, frailty, and socioeconomic factors may influence candidacy but are not absolute contraindications.<br /><br />Panel discussion underscored the importance of early referrals, innovative use of weight loss therapies such as GLP-1 receptor agonists and bariatric surgery to expand candidacy, and individualized patient care plans. Speakers encouraged communication between referring centers and advanced heart failure programs to improve timely evaluation and maximize patient survival and quality of life.

Keywords

Advanced Heart Failure

HPSA Seminar

Heart Failure Therapies

LVAD

Heart Transplantation

Inotropes

Risk Stratification

Multidisciplinary Evaluation

Social Determinants of Health

Donor-Recipient Matching