An updated review of cardiac devices in heart failure.
BACKGROUND
Heart failure has the highest rates of adult hospitalisations, the highest mortality rates and significant costs associated with its care. The cost of heart failure is expected continue to grow on a global scale, with $108 billion spent on heart failure in 2012. Mortality rates are high, with incident cases of heart failure resulting in 30% 1-year mortality, and in hospital mortality of acute heart failure, 28%.


RESULTS
This article reviews the devices currently in use for the treatment of heart failure, as well as those that are under investigation. A review of the mechanism of action of devices, the literature supporting their application as therapy, and the cost effectiveness associated with their use are discussed. Conventional techniques discussed herein include the guideline-supported therapies of mechanical circulatory support (MCS) and cardiac resynchronisation therapy (CRT). Novel devices that are discussed include invasive physiological monitoring, neuromodulation, percutaneous ventricular assist devices (VADs) and cardiac contractility modulation (CCM). There has been advancement in mechanical circulatory support devices for the treatment of both acute and chronic heart failure. In addition to MCS, only CRT has resulted in reduced mortality.


CONCLUSIONS
Due to the clinical and economic arguments, treatment of heart failure is said to be the biggest unmet need in cardiology today. The data reviewed herein support this statement.
Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland (NUI), Galway, Ireland.|CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland.
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Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland (NUI), Galway, Ireland. haroon.zafar@nuigalway.ie.|Lambe Institute for Translational Research, NUI, Galway, Ireland. haroon.zafar@nuigalway.ie.
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Zafar
Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland (NUI), Galway, Ireland.|CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland.|Lambe Institute for Translational Research, NUI, Galway, Ireland.|Department of Cardiology, University Hospital Galway, Galway, Ireland.|BioInnovate Ireland, Galway, Ireland.
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Sharif
D058406:Cardiac Resynchronization Therapy / Q000191:economics* / Q000379:methods*; D006333:Heart Failure / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome
Cardiac devices; Heart failure; Implantable cardioverter-defibrillator (ICD); Treatment monitoring