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

2 www.escardio.org/guidelines

3 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 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 I A is encouraged in stable patients with HFrEf to reduce the risk of HF hospitalisation. www.escardio.org/guidelines

6 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 Taylor et al. 2014 www.escardio.org/guidelines

Extended recommendations for multidisciplinary management and monitoring of patients with HF www.escardio.org/guidelines

8 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) 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 of advanced care plan www.escardio.org/guidelines

14 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 ) www.escardio.org/guidelines

15 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 www.escardio.org/guidelines