#ACC21 came and went, bringing the usual flurry of practice-changing clinical trials, new scientific theories and inquiries, and a wealth of creative ideas showcased through poster presentations. While the virtual format is quite the departure from the in-person atmosphere, it allows flexibility in viewing sessions on-demand and allows individuals that may have an otherwise challenging time traveling to join the discussion. Aside from the trials and presentations that got the most headlines, I wanted to highlight a talk within the advanced heart failure space that expanded on a challenging clinical scenario we encounter routinely. This blog contains screenshots that are directly from the talk Moving Beyond NYHA Class: Risk Stratification and Prognosis in Advanced Heart Failure (within Session 603 The Advanced Heart Failure Therapies of LVAD and Transplant: Who, What, When, Where, Why, and How?) by Dr. Garrick Stewart from Brigham and Women’s Hospital.
Dr. Stewart starts with an overview of how we think about and classifies patients who have heart failure, starting with the history of the New York Heart Association Class grading schema. While it is simple to use and universally known, its limited in its ability to discriminate how sick those with heart failure truly are. Specifically, it cannot tell you who is at the highest risk for morbidity and mortality. To try and address those specifically with advanced heart failure, the INTERMACS Profiles were created. He outlines in his talk how these schemes are related
While this helps us think more critically about this patient population, there remains the issue of knowing who to refer for advanced heart failure therapies. Timing is anything from trivial, as those that are referred too late have worse outcomes, and those that are referred too early are placed at the risks associated with the therapies before they may actually need them. A commonly used mnemonic to remind clinicians of red flags for patients with advanced heart failure is “I NEED HELP.” If your patients has any of these criteria, and certainly if they have several, it may be time to refer.
Despite this, improvements in the referral process are still needed. Thankfully this is an area of active investigation! Congrats to Dr. Stewart on creating this excellent review.
Stewart, Garrick. Moving Beyond NYHA Class: Risk Stratification and Prognosis in Advanced Heart Failure. Session 603 The Advanced Heart Failure Therapies of LVAD and Transplant: Who, What, When, Where, Why, and How? ACC 2021 Scientific Session. May 15, 2021.
“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”