Advanced Devices for Heart Failure: Selecting, Sequencing, and Sustaining Care-Advanced Devices for Heart Failure: Selecting, Sequencing, and Sustaining Care

Video Transcription

Video Summary

The video features expert cardiologists discussing device-based management of heart failure (HF), emphasizing patient selection, monitoring, and advanced therapies. Dr. Supriya Shor outlines HF progression, highlighting stage C and D mortality risks and the importance of early aggressive management. Monitoring strategies include daily weight and vital checks, remote pulmonary artery pressure sensors (CardioMEMS, Cordella), and implanted multi-parametric ICD systems (HeartLogic). These tools help titrate medications and reduce hospitalizations, though patient compliance remains a challenge. Dr. Lindsay Arora reviews advanced device therapies: cardiac resynchronization therapy (CRT) benefits patients with reduced ejection fraction and wide QRS complexes; cardiac contractility modulation (CCM) improves symptoms in select patients not eligible for CRT; baroreflex activation therapy (BAT) modulates autonomic tone to improve symptoms. She also emphasizes multidisciplinary care and criteria for advanced heart failure stages guiding device or transplant candidacy. Dr. Milena Ianni presents a case illustrating sequential device therapy: optimization with CRT, symptom persistence managed with CCM, remote monitoring via pulmonary artery sensors for volume status, and eventual implantation of a left ventricular assist device (LVAD) when symptoms remain severe. Key messages stress the stepwise approach—starting with guideline-directed medical therapy, then CRT/ICD, followed by patient-tailored monitoring and advanced devices, with shared decision-making guiding timing for LVAD or transplant evaluation to optimize quality of life and reduce hospitalizations in HF patients.

Keywords

heart failure

device-based management

cardiac resynchronization therapy

cardiac contractility modulation

baroreflex activation therapy

remote pulmonary artery pressure monitoring

left ventricular assist device