#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.
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Baljash Cheema is a second-year cardiology fellow at Northwestern University in Chicago, Illinois. While he has loved his experience in all aspects of cardiovascular medicine, he plans to specialize in advanced heart failure and transplant and care for our sickest. He has a particular interest in improving patient care using machine learning and artificial intelligence. When he isn’t in the hospital, he enjoys spending time with his family and friends and watching sports with his wife. Follow him on twitter: @JCheemaMD