The new ESC Guidelines: Focus on chronic heart failure - - PowerPoint PPT Presentation

The new ESC Guidelines: Focus on chronic heart failure Multidisciplinary team management

Jillian Riley Imperial College, London

www.escardio.org/guidelines

2

www.escardio.org/guidelines

Multidisciplinary team management

• Organisation of care
• Discharge planning
• Lifestyle advice
• Exercise training
• Follow-up and monitoring
• The older adult, frailty and cognitive impairment
• Palliative and end-of-life care

3

www.escardio.org/guidelines

Extended recommendations for exercise, multidisciplinary management and monitoring of patients with HF

www.escardio.org/guidelines

Recommendations for exercise training

It is recommended that regular aerobic exercise is encouraged in stable patients with HFrEf to reduce the risk of HF hospitalisation. I A

www.escardio.org/guidelines

Evidence

• Cochrane review of 33 studies
• N = 4740
• HFrEF
• Intervention: Aerobic exercise
• Results:
• Mortality: RR 0.93, 95% CI 0.69 – 1.27, p = 0.59
• Hospitalisation: RR 0.75, 95% CI 0.62 – 0.91, p = 0.005
• HF hospitalisation: RR 0.61, 95% CI 0.46 – 0.8, p = 0.002

6

Taylor et al. 2014

www.escardio.org/guidelines

Extended recommendations for multidisciplinary management and monitoring of patients with HF

www.escardio.org/guidelines

Evidence

• COACH-2 trial
• N= 189
• Optimal medication, optimal education, stable
• Intervention: 12 month follow-up in primary care or HF clinic
• Results: no difference in guideline adherence
• No difference in mortality (p=0.48)
• No difference in HF hospitalisation ( p = 0.882)

8

www.escardio.org/guidelines

14.3: Practical advice on providing lifestyle advice

Key changes:

• Professional behaviours
• Focus on individualising information
• Shared decision making

www.escardio.org/guidelines

14.6: Practical advice on monitoring and follow-up in the older adult, frailty and cognitive impairment

www.escardio.org/guidelines

14.6: Practical advice on monitoring and follow-up in the older adult, frailty and cognitive impairment

Frailty scores:

• Walking speed
• Timed up-and-go test
• Frail score
• Short physical performance battery

Cognitive function:

• Mini Mental State

Examination (MME)

• Montreal Cognitive

Assessment (MOCA)

www.escardio.org/guidelines

14.7: Practical advice for palliative care

Palliative care approaches include:

• Frequent assessment of symptoms and focus on symptom management
• Should be introduced early in the HF trajectory
• Involve frequent discussion between patient, cardiologist, nurse and

genera; practitioner.

• Liaison between specialist palliative care and HF team

www.escardio.org/guidelines

14.7 Key components of palliative care service in patients with heart failure

Practical advice on symptom palliation:

• Morphine
• Oxygen
• Diuretics
• HF medication

Practical advice on components

• f advanced care plan

www.escardio.org/guidelines

Objective assessment of patient symptoms and need

Palliative care outcome scores in clinical practice:

• Palliative care Outcome Scale,
• Karnofsky Performance Status,
• Functional Assessment of Chronic Illness Therapy - Palliative Care (FACIT
• Pal)

14

www.escardio.org/guidelines

Conclusion

Recommendations (I A)

• Encourage regular exercise in patient with HF
• Enroll patients in multidisciplinary care management programme

Recommendations (IIb B)

• Follow-up and Monitoring

Practical advice

• Discharge planning
• Life style advice and shared decision making
• The older adult, frailty and cognitive impairment
• Palliative and end of life care

15