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The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease

Research output: Contribution to journalReview articlepeer-review

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The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease. / Gill, Harminder; Chehab, Omar; Allen, Christopher et al.

In: EUROPEAN JOURNAL OF HEART FAILURE, Vol. 23, No. 8, 08.2021, p. 1325-1333.

Research output: Contribution to journalReview articlepeer-review

Harvard

Gill, H, Chehab, O, Allen, C, Patterson, T, Redwood, S, Rajani, R & Prendergast, B 2021, 'The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease', EUROPEAN JOURNAL OF HEART FAILURE, vol. 23, no. 8, pp. 1325-1333. https://doi.org/10.1002/ejhf.2097

APA

Gill, H., Chehab, O., Allen, C., Patterson, T., Redwood, S., Rajani, R., & Prendergast, B. (2021). The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease. EUROPEAN JOURNAL OF HEART FAILURE, 23(8), 1325-1333. https://doi.org/10.1002/ejhf.2097

Vancouver

Gill H, Chehab O, Allen C, Patterson T, Redwood S, Rajani R et al. The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease. EUROPEAN JOURNAL OF HEART FAILURE. 2021 Aug;23(8):1325-1333. https://doi.org/10.1002/ejhf.2097

Author

Gill, Harminder ; Chehab, Omar ; Allen, Christopher et al. / The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease. In: EUROPEAN JOURNAL OF HEART FAILURE. 2021 ; Vol. 23, No. 8. pp. 1325-1333.

Bibtex Download

@article{545c37b378b9461ab06f9f719e523efc,
title = "The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease",
abstract = "Heart failure is an inevitable end-stage consequence of significant valvular heart disease (VHD) that is left untreated and increasingly encountered in an ageing society. Recent advances in transcatheter procedures and improved outcomes after valve surgery mean that intervention can (and should) be considered in all patients – even the elderly and those with multiple comorbidities - at earlier stages of the natural history of primary VHD, before the onset of irreversible left ventricular dysfunction (and frequently before the onset of symptoms). All patients with known VHD should be monitored carefully in the setting of a heart valve clinic and those who meet guideline criteria for surgical or transcatheter intervention referred for intervention without delay. High quality evidence for the use of medical therapy in VHD is limited and achieving target doses in an elderly and comorbid population frequently challenging. Furthermore, determining whether the valve or ventricle is the principal disease driver is crucial (although the distinction is not always binary, and often unclear). Guideline-directed medical therapy remains the mainstay of treatment for secondary mitral regurgitation - although up to 50% of patients may fail to respond and should be considered for cardiac resynchronization, transcatheter or surgical valve intervention. Early and definitive management strategies are essential and should be overseen by a specialist Heart Team that includes a Heart Failure specialist. In this article, we provide an evidence-based summary of approaches to the medical treatment of VHD and clinical guidance for the best management of patients in situations where high quality evidence is lacking.",
author = "Harminder Gill and Omar Chehab and Christopher Allen and Tiffany Patterson and Simon Redwood and Ronak Rajani and Bernard Prendergast",
note = "Publisher Copyright: {\textcopyright} 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = aug,
doi = "10.1002/ejhf.2097",
language = "English",
volume = "23",
pages = "1325--1333",
journal = "EUROPEAN JOURNAL OF HEART FAILURE",
issn = "1388-9842",
publisher = "John Wiley & Sons, Ltd",
number = "8",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - The advantages, pitfalls and limitations of guideline-directed medical therapy in patients with valvular heart disease

AU - Gill, Harminder

AU - Chehab, Omar

AU - Allen, Christopher

AU - Patterson, Tiffany

AU - Redwood, Simon

AU - Rajani, Ronak

AU - Prendergast, Bernard

N1 - Publisher Copyright: © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/8

Y1 - 2021/8

N2 - Heart failure is an inevitable end-stage consequence of significant valvular heart disease (VHD) that is left untreated and increasingly encountered in an ageing society. Recent advances in transcatheter procedures and improved outcomes after valve surgery mean that intervention can (and should) be considered in all patients – even the elderly and those with multiple comorbidities - at earlier stages of the natural history of primary VHD, before the onset of irreversible left ventricular dysfunction (and frequently before the onset of symptoms). All patients with known VHD should be monitored carefully in the setting of a heart valve clinic and those who meet guideline criteria for surgical or transcatheter intervention referred for intervention without delay. High quality evidence for the use of medical therapy in VHD is limited and achieving target doses in an elderly and comorbid population frequently challenging. Furthermore, determining whether the valve or ventricle is the principal disease driver is crucial (although the distinction is not always binary, and often unclear). Guideline-directed medical therapy remains the mainstay of treatment for secondary mitral regurgitation - although up to 50% of patients may fail to respond and should be considered for cardiac resynchronization, transcatheter or surgical valve intervention. Early and definitive management strategies are essential and should be overseen by a specialist Heart Team that includes a Heart Failure specialist. In this article, we provide an evidence-based summary of approaches to the medical treatment of VHD and clinical guidance for the best management of patients in situations where high quality evidence is lacking.

AB - Heart failure is an inevitable end-stage consequence of significant valvular heart disease (VHD) that is left untreated and increasingly encountered in an ageing society. Recent advances in transcatheter procedures and improved outcomes after valve surgery mean that intervention can (and should) be considered in all patients – even the elderly and those with multiple comorbidities - at earlier stages of the natural history of primary VHD, before the onset of irreversible left ventricular dysfunction (and frequently before the onset of symptoms). All patients with known VHD should be monitored carefully in the setting of a heart valve clinic and those who meet guideline criteria for surgical or transcatheter intervention referred for intervention without delay. High quality evidence for the use of medical therapy in VHD is limited and achieving target doses in an elderly and comorbid population frequently challenging. Furthermore, determining whether the valve or ventricle is the principal disease driver is crucial (although the distinction is not always binary, and often unclear). Guideline-directed medical therapy remains the mainstay of treatment for secondary mitral regurgitation - although up to 50% of patients may fail to respond and should be considered for cardiac resynchronization, transcatheter or surgical valve intervention. Early and definitive management strategies are essential and should be overseen by a specialist Heart Team that includes a Heart Failure specialist. In this article, we provide an evidence-based summary of approaches to the medical treatment of VHD and clinical guidance for the best management of patients in situations where high quality evidence is lacking.

UR - http://www.scopus.com/inward/record.url?scp=85100560191&partnerID=8YFLogxK

U2 - 10.1002/ejhf.2097

DO - 10.1002/ejhf.2097

M3 - Review article

C2 - 33421239

AN - SCOPUS:85100560191

VL - 23

SP - 1325

EP - 1333

JO - EUROPEAN JOURNAL OF HEART FAILURE

JF - EUROPEAN JOURNAL OF HEART FAILURE

SN - 1388-9842

IS - 8

ER -

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