Becnel Miriam F, Ventura Hector O, Krim Selim R
Division of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA, United States; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, United States.
Division of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA, United States; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, United States; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, United States.
Prog Cardiovasc Dis. 2017 Sep-Oct;60(2):205-214. doi: 10.1016/j.pcad.2017.08.003. Epub 2017 Aug 9.
Despite the tremendous progress made in the management of heart failure (HF), many patients reach advanced stages. This paper aims to present a practical approach to the stage D HF patient who is no longer responding to optimal medical therapy. We discuss all available therapies for this patient population. We also offer some important caveats with regard to identification, risk stratification, evaluation and treatment including early patient referral to a center with an advanced HF program. Given the changing landscape of heart transplantation and an impending change in the allocation system, we also intend to engage a discussion on the need for a paradigm shift towards left ventricular assist device therapy in this population.
尽管在心力衰竭（HF）管理方面取得了巨大进展，但许多患者仍会发展到晚期。本文旨在介绍一种针对不再对最佳药物治疗有反应的D期HF患者的实用方法。我们讨论了针对这一患者群体的所有可用治疗方法。我们还就识别、风险分层、评估和治疗提出了一些重要的注意事项，包括早期将患者转诊至设有晚期HF项目的中心。鉴于心脏移植情况的变化以及分配系统即将发生的改变，我们还打算就该人群向左心室辅助装置治疗转变的范式转变需求展开讨论。
