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New guidelines for global heart patient management

The first international guidelines for heart failure patient management, mainly before heart transplantation, by the International Society// for Heart and Lung Transplantation (ISHLT) has been published in the Sept. 2006 issue of the Journal of Heart and Lung Transplantation. These complete and global guidelines will help overcome the present principles failures and will guide practicing physicians and cardiologists worldwide.

The severe state in which the heart fails to pump sufficient blood into the body is called heart failure. According to the statistical data from the National Heart Lung Blood Institute and other sources, nearly 100 million people around the world suffer from heart failure and around 12 million new cases are reported every year.

Over the past decade, advancements in patient care with ventricular assist and other implantable devices, stem cell implants, biomedical developments and improved pharmaceutical management, have had a dramatic impact on care for heart failure patients. Taking these and other advancements into consideration, the new guidelines underscore the optimal process for managing heart failure patients prior to considering transplantation.

"The new guidelines will enhance the effectiveness of patient care, optimize patient outcomes, and improve the overall cost of patient care by focusing resources on the most effective strategies," said Mariell Jessup, M.D., ISHLT task force chair and Professor of Medicine at the University of Pennsylvania.

"Our goal is to reach cardiologists and other physicians around the globe who don't currently have resources available to help treat their patients suffering with advanced heart failure," said Edoardo Gronda, M.D., ISHLT task force chair and Director of Clinical Cardiology and Heart Failure Unit, Istituto Clinico Humanitas, Milan, Italy. "In turn, we are working to help standardize treatment for patients regardless of where they are located."

Recognizing a need for standardized treatment around the globe, ISHLT initiated a review process more than two years ago, establishing a series of task forces utilizing a diverse group of its members who are active in heart failure and transplant medicine. The task forces reviewed criteria for placing patients on waiting lists for donor organs as well as pharmacological, surgical and device-based intervention to successfully bridge patients to transplant.

International collaboration within ISHLT made possible a global perspective that takes into consideration the barriers to transplantation in different countries, reviewing varied healthcare systems and economic factors that influence medical care for heart-failure patients.

"While there are several agencies worldwide that review and address guidelines for treatment and management of heart failure in patients, none are comprehensive," explained Mandeep Mehra, M.D., University of Maryland School of Medicine and ISHLT task force chair. "With our international membership, ISHLT is in the ideal position to advocate comprehensive guidelines for the global medical community."

A Comprehensive International Approach To develop the new guidelines, ISHLT convened three international task forces to examine particular areas of consideration in heart failure patient management. Each task force consisted of an international mix of society members charged with reviewing and deliberating specific issues of importance to heart failure patient management. The final recommendations of the task forces were reviewed by a blinded, independent, international editorial review board and then presented to the ISHLT board of directors for approval.

Revisiting Listing Criteria for Heart Transplantation The first task force, charged with Revisiting Listing Criteria for Heart Transplantation, produced a report particularly focused on patient outcomes. This task force, working to balance societal need s with individual patient needs, presented a clear consensus on how to allocate the finite resources available, meaning the finite number of donor organs available for transplant.

Optimal Pharmacological and Non-Pharmacological Management Of Cardiac Transplant Patients The second task force focused on Optimal Pharmacological and Non-pharmacological Management of Cardiac Transplant Patients and approaches to be considered prior to transplant evaluation. The recommendations acknowledge the goal to reduce the death rate of patients while waiting for transplantation and identifies the need to provide the best available medical therapy prior to consideration for transplant. The task force outlines the necessary steps to follow prior to recommending a patient for transplantation, but also explores how to avoid transplantation, including the possible role of investigational drug therapies in delaying or avoiding transplant. Finally, this task force's report emphasizes the need for end-of-life discussions with all patients facing advanced heart failure.

Heart Rhythm Considerations In Heart Transplant Candidates and Considerations For Ventricular Assist Devices The third task force examined Heart Rhythm Considerations in Heart Transplant Candidates, particularly studying the role of ventricular assist devices in transplantation. This task force's report outlines the critical role of device-based therapy, including pacemakers and defibrillators, for patients with heart failure under consideration for heart transplant.

Overall, the new guidelines provide a succinct template for any cardiologist or practicing physician around the world who may refer patients for heart transplants.


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