Novel Medical Treatments and Devices for the Management of Heart Failure with Reduced Ejection Fraction

Heart failure (HF) is a growing issue in developed countries; it is often the result of underlying processes such as ischemia, hypertension, infiltrative diseases or even genetic abnormalities. The great majority of the affected patients present a reduced ejection fraction (≤40%), thereby falling under the name of "heart failure with reduced ejection fraction" (HFrEF). This condition represents a major threat for patients: it significantly affects life quality and carries an enormous burden on the whole healthcare system due to its high management costs. In the last decade, new medical treatments and devices have been developed in order to reduce HF hospitalizations and improve prognosis while reducing the overall mortality rate. Pharmacological therapy has significantly changed our perspective of this disease thanks to its ability of restoring ventricular function and reducing symptom severity, even in some dramatic contexts with an extensively diseased myocardium. Notably, medical therapy can sometimes be ineffective, and a tailored integration with device technologies is of pivotal importance. Not by chance, in recent years, cardiac implantable devices witnessed a significant improvement, thereby providing an irreplaceable resource for the management of HF. Some devices have the ability of assessing (CardioMEMS) or treating (ultrafiltration) fluid retention, while others recognize and treat life-threatening arrhythmias, even for a limited time frame (wearable cardioverter defibrillator). The present review article gives a comprehensive overview of the most recent and important findings that need to be considered in patients affected by HFrEF. Both novel medical treatments and devices are presented and discussed.

Wearable cardioverter defibrillators in schools: A guide for parents and educators

Keeping children safe is a goal for everyone. To stay safe, some children need a wearable cardioverter defibrillator (WCD). WCDs protect individuals who are at risk for life-threatening arrhythmias. The LifeVest^® (ZOLL, Pittsburgh, PA, USA) is a WCD that identifies, records, and treats potentially life-threatening abnormal heartbeats, or arrhythmias. The WCD will provide electrical energy to the heart with up to five high-energy shocks if a potentially dangerous cardiac arrhythmia is detected. This type of arrhythmia, if not treated within a short time period (less than 2 minutes), can result in disruption of blood flow to the brain and other vital organs (that is, a sudden cardiac arrest), and death can occur within minutes. A shock delivered by the LifeVest can terminate an arrhythmia and restore a normal heart rhythm and blood flow to the body. In December 2015, the Food and Drug Administration approved the LifeVest for patients under 18 years old. The purpose of this guide is to serve as a resource for parents and educators, to promote awareness of the LifeVest, and to answer questions about the safety of the LifeVest in schools.