PhD defence S.P. (Sumant) Radhoe

Summary:

Heart failure (HF) is a complex clinical syndrome and is considered a major global health problem with a prevalence of 1-2% among adults which is expected to increase even further. The prognosis of HF patients has been improving, but is still seriously affected with detrimental effects on survival and quality of life. The cornerstone treatment of HF with a reduced ejection fraction (HFrEF) consists of pharmacotherapy, for which healthcare professionals adhere to international guidelines based upon clinical evidence. It is known from previous research that, overall, implementation of guideline-directed medical therapy is suboptimal. Another emerging option for the management of HF patients is remote monitoring, which aims to reduce the risk of mortality and HF hospitalization. There have been important advances in this area, and emphasis has lately been on remote hemodynamic monitoring with the CardioMEMS HF system, which is a sensor developed for measurement of pulmonary artery pressures as a surrogate of intracardiac filling pressures. Currently, there is a high need for European data from a randomized controlled trial. Finally, despite all possible treatment options, 10-15% of all HF patients are believed to suffer from advanced HF, which is a state characterized by severe and persistent symptoms, and is associated with high morbidity and mortality. The prognosis of advanced HF patients is poor, but left ventricular assist device (LVAD) therapy is emerging as a beneficial treatment option for this subgroup of high-risk HF patients. The general aim of this thesis was to study heart failure treatment and advances in HF therapy across the full spectrum in an attempt to further improve the management of HF patients.