LVADs: A Rapidly Evolving Alternative to Transplant
LVADs: A Rapidly Evolving Alternative to Transplant
Left ventricular assist devices are becoming an increasingly prevalent therapy for patients with Stage D heart failure with reduced ejection fraction. Technological advances have improved the durability of these devices and have significantly lengthened survival in these patients. Quality of life is also improved, although adverse events related to device therapy remain common. Nevertheless, with the continuing organ donor shortage for cardiac transplantation, left ventricular assist devices are frequently serving as a substitute for transplant, particularly in the elderly patient.
Heart failure (HF) incidence and prevalence is increasing at epidemic proportions. This rise in HF incidence is, in part, due to the success cardiologists have made in salvaging patients who have acute myocardial infarctions. Improved survival in patients with HF and the aging of the population has contributed to the increasing prevalence of HF. In the United States alone, 5.8 million Americans have HF. The incidence is estimated at 650,000 new cases annually, with over a million annual hospital admissions. More than 300,000 deaths/year are attributed to HF, and the annual cost to manage these patients is close to $40 billion. Approximately 50% of the HF population has heart failure with reduced ejection fraction (HFrEF). In this subset of patients, probably 10% have advanced symptoms (New York Heart Association [NYHA] functional class IIIB to IV), yielding an estimated cohort of approximately 200,000 to 250,000 patients who will be the focus of our review.
Abstract and Introduction
Abstract
Left ventricular assist devices are becoming an increasingly prevalent therapy for patients with Stage D heart failure with reduced ejection fraction. Technological advances have improved the durability of these devices and have significantly lengthened survival in these patients. Quality of life is also improved, although adverse events related to device therapy remain common. Nevertheless, with the continuing organ donor shortage for cardiac transplantation, left ventricular assist devices are frequently serving as a substitute for transplant, particularly in the elderly patient.
Introduction
Heart failure (HF) incidence and prevalence is increasing at epidemic proportions. This rise in HF incidence is, in part, due to the success cardiologists have made in salvaging patients who have acute myocardial infarctions. Improved survival in patients with HF and the aging of the population has contributed to the increasing prevalence of HF. In the United States alone, 5.8 million Americans have HF. The incidence is estimated at 650,000 new cases annually, with over a million annual hospital admissions. More than 300,000 deaths/year are attributed to HF, and the annual cost to manage these patients is close to $40 billion. Approximately 50% of the HF population has heart failure with reduced ejection fraction (HFrEF). In this subset of patients, probably 10% have advanced symptoms (New York Heart Association [NYHA] functional class IIIB to IV), yielding an estimated cohort of approximately 200,000 to 250,000 patients who will be the focus of our review.
