2023 | HFSA

Consensus Statement Released by HFSA Offers Best Practices on the Medical Management of Patients on Durable Mechanical Circulatory Support

HFSA News Heart Failure Guidelines

ROCKVILLE, MD (February 22, 2023) — An expert consensus statement published today by the Heart Failure Society of America (HFSA) offers best practices in the management of patients on durable Mechanical Circulatory Support (MCS), focusing on pharmacological therapies administered to patients on continuous flow Left Ventricular Assist Devices (LVADs). 

“Over the last two decades, durable MCS for the management of advanced heart failure has enjoyed a remarkable evolution, generating smaller and more hemocompatible devices with more favorable side-effect profiles, yielding progressive gains in short- and long-term survival. However, proficient medical management of patients on durable LVAD support is necessary to increase their quantity and quality of life," said Barry Trachtenberg, MD, lead author and Cardiologist at Houston Methodist Heart and Vascular Center. "This consensus statement will provide clinicians with practical information they need to make decisions and support optimal patient care for the management of this unique population.”

As patients live longer on LVAD support, attention to the medical management of patients on durable LVAD support is paramount for advancing long-term outcomes. The consensus statement was created to provide a guide in the following areas:

  • Guideline Directed Medical Therapies in Patients on Durable MCS
  • Medical Therapy Directed at Complications Encountered in Patients on Durable MCS
    • Management of Right Ventricular Failure and Pulmonary Hypertension
    • Identifying and Managing Vasoplegia Perioperatively
    • Management of Strokes
    • Management of Arrhythmias
    • Prevention and Treatment of Mucocutaneous Bleeding 
    • Management of Infectious Complications
  • Anticoagulation and Antiplatelet Therapy Management 
  • Addressing Depression, Anxiety, and Compliance 
  • Consideration of Herbal and Nutritional Therapies 

The authors highlight the following key points:

  • Postoperative long-term GDMT is recommended for ongoing neurohormonal blockade, prevention of heart failure decompensation, arrhythmia suppression, hypertension control and mitigation of renal vascular disease. 
  • Most patients with preoperative pulmonary hypertension will experience improvements in pulmonary pressures following LVAD implant, but a minority will experience cPC-PH that can lead to RV dysfunction.
  • Aggressive preoperative optimization to reduce RV wall stress through decongestion and pulmonary vasodilator therapy, followed by careful postoperative monitoring of RV function and afterload, are critical to reduce the risk of early severe RVF.
  • Ongoing close surveillance of LVAD outpatients, monitoring for congestion or complications that can trigger RV dysfunction (excessive LVAD speeds with septal shift, arrhythmias) are crucial for preventing heart failure exacerbation during long term LVAD therapy. 
  • Meticulous driveline care for prevention of driveline and LVAD-associated infections is crucial and prompt use of appropriate antibiotics is crucial in patients with infections.
  • Current evidence is reviewed for mitigation and treatment of GIB through pharmacologic therapy. 
  • While the HeartMate 3 pump confers a lower risk of device thrombosis and ischemic stroke, anticoagulation therapy with warfarin is still required. 
  • Patient education about nutritional and herbal therapies is important to reduce the potential for interference with anticoagulant and antiplatelet management. 
  • Regular review of programmatic clinical practice guidelines and practitioner adherence to GDMT recommendations, mean arterial pressure goals, and time in therapeutic range for anticoagulation on LVAD support should be considered to ensure optimal outcomes are achieved for more patients on LVAD support. 

The HFSA Expert Consensus Statement on the Medical Management of Patients on Durable Mechanical Circulatory Support is published in the Journal of Cardiac Failure and available online at www.onlinejcf.com.

About the Heart Failure Society of America 

The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org

About the Journal of Cardiac Failure

The Journal of Cardiac Failure publishes peer-reviewed manuscripts of interest to clinicians and researchers in the field of heart failure and related disciplines. These include original communications of scientific importance and review articles involving clinical research, health services and outcomes research, animal studies, and bench research with potential clinical applications to heart failure. The Journal also publishes manuscripts that report the design of ongoing clinical trials and editorial perspectives that comment on new developments pertinent to the field of heart failure or manuscripts published in other journals.

Media Contacts:  

Laura Poko: Director of Marketing and Communications, Heart Failure Society of America, 301-798-4493, ext. 226 lpoko@hfsa.org