2 Indications and current treatments

2 Indications and current treatments

2.1 Heart failure is a complex clinical syndrome that occurs when the efficiency of the heart as a pump is impaired. It leads to reduced blood flow to body tissues and increased filling pressure in the heart. This causes congestion and oedema in the lungs (causing breathlessness) or the body (causing swelling of the legs). Other symptoms include reduced exercise tolerance, fatigue and malaise.

2.2 Medical treatment of heart failure involves drugs, including diuretics and inotropic agents. Invasive therapies include electrophysiological interventions, such as pacemakers and implantable cardioverter defibrillators, revascularisation by percutaneous coronary angioplasty and stenting or coronary artery bypass grafting, valve replacement or repair, and temporary use of intra‑aortic balloon pumps.

2.3 In chronic heart failure, conventional treatment strategies may not work, resulting in the need for heart transplantation or implantation of a ventricular assist device to provide permanent circulatory support (destination therapy). A ventricular assist device may also be used to provide temporary circulatory support while a patient waits for heart transplantation (bridge‑to‑transplantation).

2.4 Conventional heart transplantation involves removing the heart of a donor who no longer has any activity in their brainstem, and has permanently lost the potential for consciousness and the capacity to breathe autonomously. The donor heart is usually preserved using cold ischaemic storage until it is implanted into the recipient. Prolonged cold storage times may result in ischaemic and reperfusion injuries that can impair heart function after transplantation.

  • National Institute for Health and Care Excellence (NICE)