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Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care

Lookup NU author(s): Dr David Crossland

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Abstract

Copyright © 2019 Canadian Cardiovascular Society. All rights reserved.There is mounting recognition that some of the most urgent problems of adult congenital heart disease (ACHD) are the prevention, diagnosis, and management of heart failure (HF). Recent expert consensus and position statements not only emphasize a specific and pressing need to tackle HF in ACHD (ACHD-HF) but also highlight the difficulty of doing so given a current sparsity of data. Some of the challenges will be addressed by this review. The authors are from 3 different centres; each centre has an established subspeciality ACHD-HF clinic and is able to provide heart transplant, multiorgan transplant, and mechanical support for patients with ACHD. Appropriate care of this complex population requires multidisciplinary ACHD-HF teams evaluate all possible treatment options. The risks and benefits of nontransplant ACHD surgery, percutaneous structural and electrophysiological intervention, and ongoing conservative management must be considered alongside those of transplant strategies. In our approach, advanced care planning and palliative care coexist with the consideration of advanced therapies. An ethos of shared decision making, guided by the patient's values and preferences, strengthens clinical care, but requires investment of time as well as skilled communication. In this review, we aim to offer practical real-world advice for managing these patients, supported by scientific data where it exists.


Publication metadata

Author(s): Crossland DS, Van De Bruaene A, Silversides CK, Hickey EJ, Roche SL

Publication type: Review

Publication status: Published

Journal: Canadian Journal of Cardiology

Year: 2019

Volume: 35

Issue: 12

Pages: 1723-1739

Print publication date: 01/12/2019

Online publication date: 26/07/2019

Acceptance date: 23/07/2019

ISSN (print): 0828-282X

ISSN (electronic): 1916-7075

Publisher: NLM (Medline)

URL: https://doi.org/10.1016/j.cjca.2019.07.626

DOI: 10.1016/j.cjca.2019.07.626

PubMed id: 31813505


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