Example: stock market

NYHA Class II or III Heart Failure: Who Will Need an ...

World Journal of Cardiovascular Diseases, 2016, 6, 372-381 ISSN Online: 2164-5337 ISSN Print: 2164-5329 DOI: October 18, 2016 NYHA Class II or III Heart Failure: Who Will Need an implantable cardioverter defibrillator (ICD)? Irtiza Hasan1,2*, Muhammad Tofazzal Hossain3, Md. Harun Ur Rashid Bhuiyan4 1 Cardiology, Canterbury Christ Church University, Canterbury, UK 2 Internal Medicine, The University of Edinburgh, Edinburgh, UK 3 Cardiology, Universal Medical College, Dhaka, Bangladesh 4 Clinical & Interventional Cardiology, Sikder Cardiac Care & Research Centre, Dhaka, Bangladesh Abstract Sudden cardiac death (SCD) is one of the most debilitating and life-threatening complications of Heart failure (HF) which has challenged medical care for long. Cur-rent guidelines suggest the use of implantable cardioverter defibrillator (ICD) in primary prevention of SCD in both New York Heart Association (NYHA) Class II and Class III Heart failure.

DOI: 10.4236/wjcd.2016.610042 October 18, 2016 NYHA Class II or III Heart Failure: Who Will Need an Implantable Cardioverter Defibrillator (ICD)? Irtiza Hasan1,2*, Muhammad Tofazzal Hossain3, Md. Harun Ur Rashid Bhuiyan4 1Cardiology, Canterbury Christ Church University, Canterbury, UK

Tags:

  Implantable, Defibrillator, Implantable cardioverter defibrillator, Cardioverter

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of NYHA Class II or III Heart Failure: Who Will Need an ...

1 World Journal of Cardiovascular Diseases, 2016, 6, 372-381 ISSN Online: 2164-5337 ISSN Print: 2164-5329 DOI: October 18, 2016 NYHA Class II or III Heart Failure: Who Will Need an implantable cardioverter defibrillator (ICD)? Irtiza Hasan1,2*, Muhammad Tofazzal Hossain3, Md. Harun Ur Rashid Bhuiyan4 1 Cardiology, Canterbury Christ Church University, Canterbury, UK 2 Internal Medicine, The University of Edinburgh, Edinburgh, UK 3 Cardiology, Universal Medical College, Dhaka, Bangladesh 4 Clinical & Interventional Cardiology, Sikder Cardiac Care & Research Centre, Dhaka, Bangladesh Abstract Sudden cardiac death (SCD) is one of the most debilitating and life-threatening complications of Heart failure (HF) which has challenged medical care for long. Cur-rent guidelines suggest the use of implantable cardioverter defibrillator (ICD) in primary prevention of SCD in both New York Heart Association (NYHA) Class II and Class III Heart failure.

2 This paper critically evaluated the evidence underlying the guideline recommendation. In contrast to recent guidelines, the majority of the in-tervention trials conducted on the topic till date found a promising role of ICD only in the prevention of SCD in NYHA Class II HF. One of the trials which found a sig-nificant role of ICD in type III Heart failure was underpowered. Thus, further trials are needed to validate the use of ICD in the prevention of SCD in type III HF. Keywords Heart Failure, Sudden Cardiac Death, implantable cardioverter defibrillator , ICD, NYHA, ESC 1. Introduction Clinically, Heart failure (HF) is defined as a syndrome characterized by some cardinal features (breathlessness, peripheral edema, etc.) due to a functional or structural ab-normality of the Heart , established by echocardiographic evidence, particularly as a re-duction in ejection fraction (LVEF) [1].

3 The European Society of Cardiology (ESC) in-cluded an additional criterion in the definition and that is, the response to treatment How to cite this paper: Hasan, I., Hossain, and Bhuiyan, (2016) NYHA Class II or III Heart Failure: Who Will Need an implantable cardioverter defibrillator (ICD)? World Journal of Cardiovascular Dis-eases, 6, 372-381. Received: September 5 , 2016 Accepted: October 15, 2016 Published: October 18, 2016 Copyright 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY ). Open AccessI. Hasan et al. 373 directed towards Heart failure in case of doubtful diagnoses [2]. HF is generally consi-dered as a chronic condition traditionally resulting from left ventricular dysfunction with reduced LVEF ( 40%), which can be distinguished from a small proportion of HF with preserved EF (HF PEF) [3].

4 HF is a major public health issue with substantial mortality and morbidity which also poses a challenge to clinical diagnosis and generally affects the older segment of the population [4] [5]. Various clinical conditions includ-ing ischemic and non-ischemic Heart diseases, metabolic and endocrine diseases, infec-tious and chronic diseases, use of cardiac and non-cardiac cardiotoxic drugs are some of the common factors causing HF [6]-[11]. The prevalence of HF has an increasing trend with 23 million people worldwide being affected in 2011 alone [4]. Framingham study indicated doubling of the incidence of HF with each increasing decade of age [12]. Various population-based studies including the Framingham study, Rochester- Epidemiology project and studies done by Cowie et al., Remes et al. found that the in-cidence rate of HF is around 1-4/1000 among the whole population and up to 16/1000 among those >65 years of age [1] [8].

5 Men are more frequently affected compared to the females [2]. The lifetime risk of developing HF is calculated to be 1 in 5 [4]. HF is also associated with high rates of hospitalization, readmissions, outpatient visits and health care cost [4]. In the early 90s, HF was the single leading cause of hospitalization and accounts for of the admissions per annum in the European countries and has reached an epidemic proportion in many countries globally [1] [8] [12]. However, in the recent era with the development of newer and effective treatment strategies, there has been a relative reduction in hospitalization rate due to HF by 30% to 50% along with a slight decrease in mortality [1]. It is also associated with a significant portion of healthcare cost globally and exceeds $39 billion/year in the US only [4].

6 The increasing prevalence of HF coupled with its substantial impact on healthcare cost and quality of life is a major public health problem globally and emphasizes the need for better and effective preventive strategies for the management of HF. 2. New York Heart Association (NYHA) Classification of HF The NYHA classification is one of the most commonly used classification of HF, which is a functional classification based on patient s limitation in physical activity/exertion caused by cardiac symptoms are given in Table 1 [13]. Table 1. NYHA classification of Heart failure. Heart failure Symptoms Objective Assessment Class I No limitation of physical activities. Ordinary physical activities do not cause any symptom No objective evidence of cardiovascular disease Class II Slight limitation of physical activities. Comfortable at rest.

7 Ordinary physical activities may cause symptoms like fatigue, palpitation, dyspnea Objective evidence of minimal cardiovascular disease Class III Marked limitation of physical activities. Comfortable at rest. Less than ordinary activities may cause symptoms like fatigue, palpitation, dyspnea Objective evidence of moderately severe cardiovascular disease Class IV Inability to carry out any physical activities without discomfort. Symptoms of Heart failure present even at rest Objective evidence of severe cardiovascular disease I. Hasan et al. 374 3. Sudden Cardiac Death (SCD) HF is a chronic debilitating condition & half of all the patients who develop HF die within 5 years of diagnosis with an annual mortality rate as high as 50% [14] [15]. Ac-cording to Rotterdam study, the age-adjusted mortality rate in HF was twice that of non-HF-related deaths [8].

8 Though the exact cause of death due to HF is poorly un-derstood but according to a study done by Derfler et al. the mode of death in HF pa-tient included metabolic ( ), progressive failure ( ), SCD ( ), unwit-nessed ( ) and others ( ) [16]. Another study found a fivefold increased risk of SCD in HF patients [8] [15]. SCD can be defined as an unexpected natural death occur-ring within a short period of time, generally 1 hour from the onset of symptoms, usually due to cardiac causes in a person without prior fatal condition [17]. Degenera-tion of monomorphic ventricular tachycardia (VT) into ventricular fibrillation (VF) accounts for the majority of causes of SCD [18]. To complicate it all, VT has been do-cumented in 85% of patients with HF especially those with LVEF 30% to 35% [18] [19].

9 Thus, there is a large segment of HF patients who are at risk of SCD resulting from ventricular arrhythmia which necessitates the need to focus on prevention of SCD in HF patients. The initiation of SCD in HF patients is a complex interplay and delicate balance of various underlying phenomenon including anatomic and functional cardiac substrates, transient initiating events (electrolyte, drug, stress, etc.) on the various cel-lular electrical circuits including prolonging action potential, delayed repolarization, reentry circuits and so on [17]. Though the mortality rate of HF increases with increase in NYHA classes but surprisingly the highest proportion of SCD is among those with less severe HF (NYHA Class II and III) [18]. The risk of SCD among the NYHA Class II, III, and Class IV is 64%, 59% and 33% respectively [19].

10 Most of the patients who suffer from SCD do not have any antecedent arrhythmia necessitating the need to focus on primary prevention of SCD. The traditional antiarr-hythmic medications are not completely able to abort the SCD [20]. Studies including AVID, CIDS, CASH, etc. demonstrated the superiority of implantable cardioverter de-fibrillator (ICD) over antiarrhythmic medications [21]. Bardy et al. found a 23% re-duced overall mortality in HF patients using ICD [22]. 4. implantable cardioverter defibrillator (ICD) ICD is a battery-operated device, which is placed in a pouch under the skin of chest, abdomen or collar bone and has a battery unit, which generates the pulse and 1 or 2 lead(s) placed in right ventricle &/or right atrium, which communicates between Heart & device [23]. ICD regularly monitor Heart rate and rhythm and provides defibrillatory shocks or overdrive pacing in case of an abnormal or chaotic heartbeat to terminate the arrhyth-mia [1] [22] [24].


Related search queries