Abstract
Overview
Introduction
Advanced heart failure is a growing issue. Existing pharmacological strategies
increase the survival rates of acute heart failure patients, providing a
growing source of patients with advanced disease. In view of long waiting
lists for heart transplantation and the growing lack of donors, cardiac
resynchronization and mechanical circulatory support devices have demonstrated
promising results.
Scope
- What are the current definitions, diagnostic methods and treatment
approaches of the early stages of the disease?
- What are the main issues surrounding treatment approaches in the advanced
stages of the disease?
- What is the current role of cardiac resynchronization therapy in treatment
of advanced heart failure?
- What are the main non-pharmacological options as alternatives to heart
transplantation in advanced heart failure?
Report Highlights
With no new drug therapies addressing advanced heart failure and existing
pharmacological strategies failing to compensate a weakening heart,
alternative, non-pharmacological solutions have to be found. In view of long
waiting lists for heart transplantation and the growing shortage of donor
hearts, the focus of treatment must shift onto devices.
Ventricular dyssynchrony is a well recognized problem in advanced stages of
heart failure. Clinical trials investigating ventricular dyssynchrony cardiac
resynchronization have demonstrated promising results. However, this
technology provides only temporary, symptomatic relief and neither cures nor
fully stops the progression of the disease.
In light of the growing shortage of donor hearts and failing pharmacological
strategies, an artificial mechanical heart has been a long sought-after
technology. Although the developments started decades ago, a fully implantable
total artificial heart is still at the concept stage, with many years of
research and development yet to come.
Reasons to Purchase
- Understand current definitions, diagnostic methods and treatment
approaches in advanced heart failure
- Current dynamics and future trends of the technology developments treating
advanced heart failure
- Major technological and industry issues surrounding technological progress
and new product development
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE
- About the cardiovascular analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into available therapies in advancedheart failure
- Contributing experts
- CHAPTER 2 HEART FAILURE DEFINITIONS AND PATHOPHYSIOLOGY
- Definition of heart failure
- Acute heart failure
- Chronic heart failure
- Etiology of heart failure
- Segmentation of heart failure
- Disease severity
- Low versus high output failure
- Systolic versus diastolic heart failure
- Age group
- Co-morbidities, complications and risk factors
- CHAPTER 3 EPIDEMIOLOGY
- Epidemiology of heart failure
- Future incidence of acute heart failure
- Future prevalence of chronic heart failure
- Future trends in the incidence and prevalence of heartfailure
- CHAPTER 4 DIAGNOSIS AND INVESTIGATION
- Diagnosis
- Symptoms
- Neurohormonal activation markers
- Novel biomarkers
- Role of medical imaging in heart failure
- Chest x-ray
- Echocardiography
- Nuclear perfusion tests
- Role of MRI in coronary heart disease diagnosis
- CHAPTER 5 BASIC PHARMACOLOGICAL THERAPY
- Drug classes in heart failure
- ACE inhibitors
- Angiotensin II receptor blockers
- Diuretics
- Betablockers
- Digoxin
- Antithrombotics
- Calcium channel blockers
- CHAPTER 6 DEVICE THERAPIES IN HEART FAILURE
- Treatment options in advanced heart failure
- Heart transplantation
- Fundamental differences between drugs and devices
- Arrhythmia Devices in Heart Failure
- Ventricular dyssynchrony
- Role of ICD therapy
- Historical development of ICD device therapy
- Indications and guidelines for ICD therapy
- Cardiac resynchronization therapy
- CRT-P vs. CRT-D vs. ICD
- Limitations of cardiac resynchronization therapy
- Guidelines and indications
- Novel technologies
- Prevention with advanced biosensors
- Less invasion with leadless technology
- Cardiac contractility modulation therapy
- Mechanical circulatory support devices
- Ventricular Assist Devices
- Historical developments and design transformation
- Pulsatile design
- Rotary design and continuous flow
- Guidelines and indications for mechanical assistance
- Total artificial heart devices
- Counterpulsation devices without blood contact
- Short-term mechanical assistance
- Extracorporeal membrane oxygenation (ECMO)
- Intra-aortic Balloon Pumps
- Percutaneous transseptal circulatory assist devices
- Passive containment devices
- Future technology with artificial heart muscle
- Problems associated with mechanical circulatory assistdevices
- Biocompatibility, coagulation control and device surfaces
- Infection and external components
- Power sources, size and patient mobility
- Mechanical durability
- Future directions and industry challenges
- Summary of design trends
- Telemedicine for heart failure management
- Device availability
- FDA approved devices
- APPENDIX A
- Methodology
- Epidemiology
- Incidence of acute heart failure
- Prevalence of chronic heart failure
- APPENDIX B
- Report methodology
- Bibliography
- APPENDIX C
- About Datamonitor
- About Datamonitor Healthcare
- About the cardiovascular analysis team
- Disclaimer
- List of Tables
- Table 1: Causes of heart failure in the seven majormarkets (%), 2004
- Table 2: Prevalence of chronic heart failure by agegroup in the seven
major markets (000s), 2005
- Table 3: Estimated proportion of chronic heart failurepatients with
co-morbid conditions and risk factors in the seven majormarkets (%), 2004
- Table 4: Estimated incidence of acute heart failure inthe seven major
markets (000s), 2008-2016
- Table 5: Future estimated incidence of chronic heartfailure in the seven
major markets (000s), 2008-2016
- Table 6: Symptoms used in the diagnosis of chronic heartfailure in the
seven major markets, 2004
- Table 7: Symptoms observed in chronic heart failurepatients in the seven
major markets, 2004
- Table 8: Tests used in the diagnosis of chronic heartfailure in the
seven major markets, 2004
- Table 9: Proportion of patients with chronic heartfailure receiving each
diagnostic test, 2004
- Table 10: Historical development of ICD device therapy
- Table 11: Major clinical trials for CRT
- Table 12: Indications for CRT-D vs. ICD
- List of Figures
- Figure 1: Segmentation of diagnosed chronic heartfailure patients by
disease severity, 2004
- Figure 2: ACC/AHA practice guidelines for the evaluationand management
of chronic heart failure, 2005
- Figure 3: Relationship between cardiac dysfunction,heart failure and
heart failure rendered asymptomatic, as defined by theEuropean Society of
Cardiology
- Figure 4: Breakdown of heart failure patients accordingto whether
failure is systolic, diastolic or both in 7MM, 2004
- Figure 5: Staging of heart failure and associatedinterventions
- Figure 6: Prevalence of atrial fibrillation (AF) inheart failure patients
- Figure 7: Current CRT devices
- Figure 8: Ventricular assist devices and components
- Figure 9: Types of ventricular assist devices
- Figure 10: Modern pulatile ventricular assist pump
- Figure 11: Centrifugal flow ventricular assist system
- Figure 12: Jarvik Heart
- Figure 13: HeartMate II
- Figure 14: INCOR BerlinHeart
- Figure 15: CardioWest Total Artificial Heart
- Figure 16: Examples of counterpulsation devices
- Figure 17: TandemHeart pVAD
- Figure 18: Acorn CorCap
- Figure 19: Type and rates of device-relatedcomplications
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