Murphy C, Zafar H, Sharif F
Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland (NUI), Galway, Ireland.
CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland.
Ir J Med Sci. 2017 Nov;186(4):909-919. doi: 10.1007/s11845-017-1597-9. Epub 2017 Mar 25.
Heart failure has the highest rates of adult hospitalisations, the highest mortality rates and significant costs associated with its care. The cost of heart failure is expected continue to grow on a global scale, with $108 billion spent on heart failure in 2012. Mortality rates are high, with incident cases of heart failure resulting in 30% 1-year mortality, and in hospital mortality of acute heart failure, 28%.
This article reviews the devices currently in use for the treatment of heart failure, as well as those that are under investigation. A review of the mechanism of action of devices, the literature supporting their application as therapy, and the cost effectiveness associated with their use are discussed. Conventional techniques discussed herein include the guideline-supported therapies of mechanical circulatory support (MCS) and cardiac resynchronisation therapy (CRT). Novel devices that are discussed include invasive physiological monitoring, neuromodulation, percutaneous ventricular assist devices (VADs) and cardiac contractility modulation (CCM). There has been advancement in mechanical circulatory support devices for the treatment of both acute and chronic heart failure. In addition to MCS, only CRT has resulted in reduced mortality.
Due to the clinical and economic arguments, treatment of heart failure is said to be the biggest unmet need in cardiology today. The data reviewed herein support this statement.
心力衰竭导致成人住院率最高、死亡率最高且护理成本高昂。预计全球范围内心力衰竭的成本将持续增长，2012年用于心力衰竭治疗的费用达1080亿美元。死亡率很高，新发心力衰竭病例的1年死亡率为30%，急性心力衰竭的住院死亡率为28%。
本文回顾了目前用于治疗心力衰竭的设备以及正在研究的设备。讨论了设备的作用机制、支持其作为治疗手段应用的文献以及与其使用相关的成本效益。本文讨论的传统技术包括指南支持的机械循环支持（MCS）和心脏再同步治疗（CRT）。讨论的新型设备包括侵入性生理监测、神经调节、经皮心室辅助装置（VAD）和心脏收缩力调节（CCM）。用于治疗急性和慢性心力衰竭的机械循环支持设备有了进展。除了MCS，只有CRT降低了死亡率。
由于临床和经济方面的原因，心力衰竭的治疗被认为是当今心脏病学中最大的未满足需求。本文所回顾的数据支持这一说法。
