S10 Journal of Cardiac Failure Vol. 23 No. 10S October 2017 SY7-5 Frailty and Perioperative Management of Non-Cardiac Surgery Yoshiharu Kinugasa, Masayuki Hirai, Kiyotaka Yanagihara, Nobuhiko Haruki, Koichi Matsubara, Masahiko Kato, Kazuhiro Yamamoto; Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan Frailty is a vulnerable state that is increasing the risk of disability and mortality when exposed to a stressor. In patients with heart failure (HF), frailty is common, and is attributable to worse their quality of life and prognosis. Thus, early detection and intervention of frailty is indispensable for the management of patients with HF. In noncardiac surgery, reduced exercise torelance below 4 metabolic equivalents determine the perioperative morbidity and mortality, which indicated that the comprehensive perioperative assessment, including not only cardiac function, but also frailty, was required for all cardiologists. However, despite the clinical significance of frailty, the assessment and intervention for frail HF patients has not been established. Thus, in this symposium, we discuss the comprehensive perioperative management of noncardiac surgery in frail HF patients.
can occur in both valves. Although bioprosthetic valves do not require anticoagulation, they have limited durability, particularly in the younger patient, and acceleration of bioprostheses degeneration during pregnancy has been reported. On the other hand, mechanical heart valves have long-term durability but require lifelong anticoagulation, even in pregnancy and the postpartum period. Since pregnancy is a procoagulant state, pregnant women with mechanical heart valves are exposed to an increased risk of valve thrombosis. In addition, warfarin has potential teratogenic effect for the fetus in the first trimester, although warfarin is the most effective antigoagulant for preventing valve thrombosis in pregnant women with mechanical heart valves. The both guidelines published from the US and Euro advocate recommendations for this unique population. In this session, we will summarize the risks of pregnancy in patients with prosthetic valves and the effective anticoagulant strategies for pregnant women with mechanical heart valves.
SY9-1 Epidemiology and Real-World Issues of Elderly Patients With Chronic Heart Failure in Super-Aging Society Nobuyuki Shiba; Cardiovascular Center, International University of Health and Welfare Hospital
SY8-1 Pregnancy and Congenital Heart Disease Tokuko Shinohara; Department of Paediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan The number of pregnancy with congenital heart disease has been increasing recently along with drastically increased population of adult congenital heart disease (ACHD) patients all over the world. We have the longest history of ACHD services in Japan so that the biggest volume of ACHD patients and their pregnancies. The management of pregnant ACHD patients faces new challenges and experiences from time to time because they are truly “New Population” especially when they have complex congenital heart disease with/without complex cardiac surgeries. It is necessary for the safe and sufficient medical care before and after pregnancy that we understand haemodynamics and problems in long term after various operations such as Senning, Mustard, Rastelli, Fontan, even double switch operation, or ventricular septation. In addition to the repaired Tetralogy of Fallot, those complicated post-operative settings should be assessed clearly before pregnancy in order to predict the changes caused by pregnancy. Since pregnancy and pregnant ACHD patients are moving target, it is very important to notice the early signs for providing the right care during pregnancy. A good guide and advice to the pregnant ACHD patients at any moment contributes not only to the better course throughout pregnancy and delivery but also to the life-long cardiac history of female ACHD patients.
SY8-3 Peripartum Cardiomyopathy: How Can We Approach Such a Heterogeneous Disease? Chizuko Kamiya; Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center Peripartum cardiomyopathy (PPCM) is a rare disease that occurs during pregnancy and up to 5 months postpartum, in previously healthy women. Recent studies have revealed that 40% of PPCM patients complicated with pregnancy-induced hypertension, and from 10 to 20% of the PPCM patients had genetic etiology of dilated cardiomyopathy (DCM). A Japanese nationwide survey revealed that PPCM patients with pregnancy-induced hypertension had better cardiac function in the chronic phase, although the rate of death and cardiac parameters at diagnosis were similar in PPCM patients with or without pregnancy-induced hypertension. These findings suggest the heterogeneity of the disease, since PPCM is a diagnosis of exclusion. Anti-prolactin therapy (APT) has recently been introduced as an additional therapy for PPCM. The Japanese prospective observational survey suggested that patients with APT tended to recover their left ventricular contraction earlier in the acute phase, but showed the same recovery rate in the chronic phase as those without APT. Therefore, personalized medicine is probably important. Our experience showed that women who were complicated with pregnancy-induced hypertension ahead of diagnosis as PPCM and fully recovered cardiac function, showed good subsequent pregnancy outcomes. On the other hand, women with reduced LVEF showed more deteriorated cardiac contraction during the subsequent pregnancy. We need further investigation to assess personalized subsequent pregnancy risk.
SY8-4 Prosthetic Valves in Pregnancy Norihisa Toh, Teiji Akagi, Hiroshi Ito; Department of Cardiovascular Medicine, Okayama University, Okayama, Japan Prosthetic valves have been widely used in patients with valvular heart disease irrespective of their etiologies. Advances in surgical technique, prosthetic valve design and material, and anticoagulantion, there are increasing numbers of women with prosthetic valves reaching to childbearing age. The two types of prosthetic valve widely used are the bioprosthetic valve and the mechanical heart valve and critical complications
Heart failure (HF) is a disease of the elderly. The population aged ≥65 y.o. now accounts for 27.3% in Japan and it will reach 30% in 2025. Furthermore, the prevalence of HF becomes greater with increasing age; 13–14% of the population aged ≥80 y.o. has HF in the United States. HF is a major and growing public health problem in Japan indeed, with high morbidity, mortality, and cost. There is no distinct definition of “elderly” worldwide, but many Japanese people think it is ≥75 y.o and ≥85 years is often classified as “very elderly”. “Elderly” and “very elderly” HF patients are more likely to be female, having higher ejection fraction, increased prevalence of co-morbidities, including atrial fibrillation, hypertension cerebrovascular disease, anemia, malignancy, and chronic kidney disease. Furthermore, risk assessment should also consider conditions such as frailty, impaired functional status, disability, and dementia. Although such populations represent the majority of HF patients and demonstrate worse outcomes compared with younger patients, epidemiological findings and targeted treatment strategies have been insufficiently clarified. Furthermore, financial problems and other social issues including the limited proper patients management by their infrequent referral to cardiologists might affect the proper treatment in such patients. We must share a common strategy for treatment and care to realize the community-based integrated care systems in Japan.
SY9-4 Cardiac Rehabilitation for Very Elderly Patients With Heart Failure: What Do We Know and Where Do We Need to Go? Kentaro Kamiya; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan The number of patients with heart failure (HF) has increased with the global aging of the population. The majority of very elderly HF patients experience sarcopenia and frailty, both of which adversely affect prognosis. While there is accumulating evidence regarding the efficacy of cardiac rehabilitation (CR) for HF patients, the effectiveness of CR for frail, very elderly patients is unclear. The latest Asia-Pacific Clinical Practice Guideline for the Management of Frailty strongly recommended (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications (Dent et al, J Am Med Dir Assoc, 2017). The recent REHAB-HF pilot study, which was a multicenter cardiac rehabilitation intervention for frail elderly patients with HF, indicated that a tailored, progressive, multidomain CR intervention improved physical performance and reduced rehospitalization (Reeves et al, JACC Heart Fail, 2017). Importantly, changes in physical performance score (SPPB) explained 91% of the change in rehospitalization rate. These findings support a potential mechanistic link between physical function and rehospitalization in frail, older patients with HF. This session will review the evidence for CR in very elderly HF patients, and present ongoing work in this area.
SY9-6 Does Device Therapy Have a Crucial Role in the Treatment of Heart Failure among Very Elderly People? Koichiro Kinugawa; The 2nd Department of Internal Medicine, University of Toyama, Toyama, Japan Most of evidences for pharmacological and nonpharmacological therapy for heart failure are established in relatively younger patients. However, in our country, inhospital patients are now over 80 years old in average according to the rapid aging demographics. Especially, invasive therapy including implantable devices for heart failure needs to be discussed for the indication in terms of cost and risk and benefit in such very old patients. I will discuss in this session about the dilenmma of device therapy on cardiac resynchronization therapy, implantable cardiac defibrillator, and left ventricular assist device.