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Review
. 2014 Winter;14(4):569-75.

Systolic heart failure: knowledge gaps, misconceptions, and future directions

Rohan Samson  1 , Rohit Ramachandran  1 , Thierry H Le Jemtel  1
Affiliations
Review

Systolic heart failure: knowledge gaps, misconceptions, and future directions

Rohan Samson et al. Ochsner J. 2014 Winter.

Abstract

Background: Systolic heart failure is the final manifestation of several cardiovascular conditions. The 2001 American College of Cardiology/American Heart Association guidelines depicting the progression of heart failure (HF) from stage A through stage D are aimed at the early treatment of risk factors. However, treatment is often delayed until stage C, and as a result HF continues to impose a major burden on our healthcare industry.

Methods: We conducted an extensive literature review of the MEDLINE/PubMed database with the purpose of elucidating knowledge gaps and misconceptions regarding systolic HF.

Results: Long-term beta adrenergic blocking is the only pharmacologic intervention that reverses left ventricular remodeling. Whether beta adrenergic blocking prevents or delays left ventricular remodeling in patients at risk of HF is presently unknown. A knowledge gap also exists regarding the phenotype of patients that derives a mortality benefit from implantable cardioverter defibrillator therapy. Acute decompensated HF is a misnomer because patients with chronic HF are known to be deteriorating in the weeks preceding hospitalization. Functional class and ejection fraction are not closely correlated. Advanced HF therapies such as heart transplantation and mechanical circulatory support are available to an extremely small fraction of patients with systolic HF.

Conclusion: Concentrating efforts on the early stages of the disease process with optimal management of risk factors for HF is critical to having a significant impact on this ongoing pandemic.

Keywords: Adrenergic beta-antagonists; angiotensin-converting enzyme inhibitors; defibrillators–implantable; heart failure–systolic.

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Conflict of interest statement

The authors have no financial or proprietary interest in the subject matter of this article.

Figures

Figure 1.
Figure 1.
Comparison of patient days saved: beta blockers vs heart transplant.
Figure 2.
Figure 2.
Relationship between left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class. (Based on the author's data collected during studies of left ventricular dysfunction.)
See this image and copyright information in PMC

References

    1. Curtis LH, Whellan DJ, Hammill BG, et al. Incidence and prevalence of heart failure in elderly persons, 1994-2003. Arch Intern Med. 2008 Feb 25;168(4):418–424. - PubMed
    1. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. Circulation. 2001 Dec 11;104(24):2996–3007. - PubMed
    1. Liu L, Eisen HJ. Epidemiology of heart failure and scope of the problem. Cardiol Clin. 2014 Feb;32(1):1–8. - PubMed
    1. Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13:18–28. - PMC - PubMed
    1. Hanson SG, Bentley TS. U.S. Organ and tissue transplant cost and estimates and discussion. Milliman, Inc. 2011 April 2011. http://us.milliman.com/insight/research/health/2011-U_S_-organ-and-tissu.... Accessed September 8, 2014.

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