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
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