Integration of implantable device therapy in patients with heart failure. A clinical consensus statement from the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC)

Wilfried Mullens, Jeroen Dauw, Finn Gustafsson, Alexandre Mebazaa, Jan Steffel, Klaus K. Witte, Victoria Delgado, Cecilia Linde, Kevin Vernooy, Stefan D. Anker, Ovidiu Chioncel, Davor Milicic, Gerd Hasenfuß, Piotr Ponikowski, Ralph Stephan von Bardeleben, Friedrich Koehler, Frank Ruschitzka, Kevin Damman, Ehud Schwammenthal, Jeffrey M. TestaniFaiez Zannad, Michael Böhm, Martin R. Cowie, Kenneth Dickstein, Tiny Jaarsma, Gerasimos Filippatos, Maurizio Volterrani, Thomas Thum, Stamatis Adamopoulos, Alain Cohen-Solal, Brenda Moura, Amina Rakisheva, Arsen Ristic, Antoni Bayes-Genis, Sophie Van Linthout, Carlo Gabriele Tocchetti, Gianluigi Savarese, Hadi Skouri, Marianna Adamo, Offer Amir, Mehmet Birhan Yilmaz, Maggie Simpson, Mariya Tokmakova, Arantxa González, Massimo Piepoli, Petar Seferovic, Marco Metra, Andrew J.S. Coats, Giuseppe M.C. Rosano

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Implantable devices form an integral part of the management of patients with heart failure (HF) and provide adjunctive therapies in addition to cornerstone drug treatment. Although the number of these devices is growing, only few are supported by robust evidence. Current devices aim to improve haemodynamics, improve reverse remodelling, or provide electrical therapy. A number of these devices have guideline recommendations and some have been shown to improve outcomes such as cardiac resynchronization therapy, implantable cardioverter-defibrillators and long-term mechanical support. For others, more evidence is still needed before large-scale implementation can be strongly advised. Of note, devices and drugs can work synergistically in HF as improved disease control with devices can allow for further optimization of drug therapy. Therefore, some devices might already be considered early in the disease trajectory of HF patients, while others might only be reserved for advanced HF. As such, device therapy should be integrated into HF care programmes. Unfortunately, implementation of devices, including those with the greatest evidence, in clinical care pathways is still suboptimal. This clinical consensus document of the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) describes the physiological rationale behind device-provided therapy and also device-guided management, offers an overview of current implantable device options recommended by the guidelines and proposes a new integrated model of device therapy as a part of HF care.

Original languageEnglish
Pages (from-to)483-501
Number of pages19
JournalEuropean Journal of Heart Failure
Volume26
Issue number2
Early online date25 Jan 2024
DOIs
StatePublished - Feb 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 European Society of Cardiology.

Keywords

  • Device therapy
  • Heart failure

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