Comparing the Effectiveness of Left Ventricular Assist Device (LVAD) and Medical Management in end-stage Heart Failure

Title: Comparing the Effectiveness of Left Ventricular Assist Device (LVAD) and Medical Management in end-stage Heart Failure
Authors: Khalaf, Malak
Amjed, Nida
Date: 26-Nov-2016
Abstract: Heart Failure (HF) is a complex clinical condition caused by structural or functional cardiac disorders that impair the ability of one or both ventricles to fill with or eject blood. Although many conditions may lead to HF, the predominant causes are myocardial ischemia and high blood pressure. (1) Heart transplantation remains the gold standard therapy for end-stage HF. Nevertheless, for patients who are ineligible for transplant, the available management options include: destination therapy with left ventricular assist device (LVAD) or medical therapy (5). The purpose of this systemic review is to determine whether LVAD or medical therapy is more effective in decreasing mortality and increasing functional status (measured by 6 min walk distance) in patients with end-stage HF. A search strategy was developed and applied in both PubMed and Scopus. Key terms such as, heart failure, LVAD, medical therapy, functional status, fluid retention and quality of life were used. Exclusion criteria such as year and language of publication were applied to further refine the search results. The 12 most relevant publications were used for the purpose of this research. HF affects an estimated five million patients in the United States. Of those, 60% have heart failure with left ventricular dilation and reduced ejection fraction. LVAD is a mechanical device that is surgically implanted into the patient’s chest to help restore blood flow and thus relieve symptoms such as fatigue and shortness of breath. On the other hand, medical therapy includes aggressive use of angiotensin converting enzyme inhibitors, beta blockers, digoxin, and diuretics to relieve lung congestion, create fluid balance and improve patient symptoms. Studies show therapy with permanent LVAD device doubled the one-year survival rate of patients with end-stage HF as compared with medical treatment alone. Furthermore, LVAD patients experienced 340 days alive out of the hospital, compared with 106 for patients on medical therapy.(2)
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