HF

CSI

Workshop

"CHIP"PING AWAY AT HF: A FRANK DISCUSSION ON FRAILTY, HFREF AND PROCEDURAL INTERVENTIONS

Co-Chair(s)

• 

  Elizabeth Swiggum, MD, FRCPC

  Medical Director Heart Function Clinic
  Royal Jubilee Hospital
  University of British Columbia
• 

  Rakesh Arora, MD, PhD, FRCSC

  Head, Cardiac Surgery and Cardiac Critical Care
  University of Manitoba
  CSCS and CANCARE Society

Presenter(s)

• 

  Rakesh Arora, MD, PhD, FRCSC

  Head, Cardiac Surgery and Cardiac Critical Care
  University of Manitoba
  CSCS and CANCARE Society
• 

  Harriette Van Spall, MD MPH FRCPC

  Associate Professor of Medicine
  McMaster University, Department of Medicine
  Hamilton Health Sciences
• 

  Olga Toleva, MD, MPH, CCFP, FRCPC

  Assistant Professor Medicine, Interventional Cardiology St. Boniface Hospital
  University of Manitoba
  Member
• 

  Hung Ly, MD, SM, FRCPC

  Associate Professor
  Université de Montréal
  Université de Montréal
• 

  Najah Adreak, MD

  Research Assistant, MD, MSc student
  The university of British Columbia

Planning Committee Member(s)

• 

  David Bewick, MD, FRCPC

  Director
  Cardiac Rehabilitation and The Heart Function Clinic
  Dalhousie University
• 

  Shelley Zieroth, n/a, MD FRCPC

  President
  Canadian Heart Failure Society
  University of Manitoba
• Rodolfo P.

  Rodolfo Pike

  Nurse Practitioner
  Eastern Health
• Vladimir D.

  Vladimir Dzavik

  Director, Research and Innovation, Interventional Cardiology and CICU
  Peter Munk Cardiac Centre, University Health Network
• 

  Kim Anderson, MD, FRCPC

  Cardiologist, QEII-Halifax Infirmary
  Dalhousie University

An aging population and increasing burden of heart failure (HF) have led to challenges in decision making in medical optimization, revascularization, and valve intervention options particularly in the frail patient with HF. Frailty defined as a biological state characterized by a decrease in physiological reserves to counter stressors, is common in patients with HF and is associated with increasing age, comorbidities, and severity of HF. Although several studies have demonstrated a benefit of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) among patients with HFrEF (HF with reduced ejection fraction), most of these studies were conducted before the widespread use of drug-eluting stent (DES) technology that have reduced the need for repeat early revascularization among patients undergoing PCI. Cardiac support devices have expanded options to use PCI in CHIP (complex higher risk indicated patients) but outcomes may not be replicated in the frail subpopulation of patients with HFrEF. Furthermore, studies on outcomes and left ventricular remodeling post transcatheter aortic valve implantation (TAVI) are conflicting in the setting of HFrEF. There is also limited evidence to guide medical optimization of vulnerable, older adult patients with HF. This workshop will provide important tools and outcome data to assist in patient centered decision making relevant to frail patients with HFrEF. It will also provide a case-based discussion for audience members to probe the expert panel on advice applicable to their challenging frail patients with HFrEF.

Co-Chair: Elizabeth Swiggum
Co-Chair: Rakesh Arora
Speakers:
1. Rakesh C. Arora: Frailty assessments in older adult patients with CV disease. (7 min)
2. Harriette Van Spall: Optimizing care in the frail patient with HF (7 min)
3. Olga Toleva: TAVI or not TAVI: Does the presence of HFrEF impact outcomes? (7 min)
4. Hung Ly: Surgical ineligibility: The why and how of revascularization in the surgical turndown patient. (7 min)
Social Media Panelist: Najah Adreak CSCS trainee

 

Learning Objectives

At the conclusion of this session, participants will be able to:

• describe the clinical tools for assessing frailty in elderly patients and the options for and barriers to medical optimization of frail patients living with heart failure;
• recognize the benefits of a Heart Team approach to decision making in older adult patients and those living with heart failure; and
• describe clinical characteristics which are associated with favorable and unfavorable outcomes associated with CHIP and TAVI procedures in patients living with heart failure.