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DOI: 10.1055/a-1235-0422
Versorgung von Herzinsuffizienzpatienten – eine interdisziplinäre Herausforderung
Care of patients with chronic heart failure: an interdisciplinary challengeDie mannigfachen Erscheinungsbilder der Herzinsuffizienz führten zu komplexen Behandlungsleitlinien und Versorgungsszenarien und erfordern deshalb immer einen integrierten, multidisziplinären Versorgungsansatz. Die stetige Entwicklung der diagnostischen Möglichkeiten und Therapieoptionen muss konsequent in die Versorgung implementiert werden und erfordert eine gute Zusammenarbeit zwischen den ärztlichen und pflegenden Fachgruppen.
Abstract
The diverse manifestations of heart failure led to complex treatment guidelines and care scenarios and therefore always require an integrated, multidisciplinary care approach. Patients with chronic heart failure suffer from a large number of cardiac and noncardiac comorbidities. For example, iron deficiency leads to decreased performance and exertional dyspnea and should be diagnosed. Psychological screening questionnaires should be used for the early detection of psychological comorbidities.
ARNI and SGLT-inhibitors expand the pharmacotherapeutic possibilities and gain in importance. The constant development of diagnostic possibilities and therapeutic options must be implemented consistently into the care continuum in order to have a lasting effect. The challenge of interdisciplinary coordination can be significantly reduced through jointly agreed process logs (e. g. within the framework of integrated supply contracts or a Heart Failure Unit Network).
Schlüsselwörter
chronische Herzinsuffizienz - Komorbidität - Eisenmangel - Psyche - ARNI - SGLT2-Inhibitor - interdisziplinärKey words
chronic heart failure - comorbidity - iron deficiency - psyche - ARNI - SGLT2 inhibitor - interdisciplinaryPublication History
Article published online:
01 March 2021
© 2021. Thieme. All rights reserved.
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Literatur
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1
Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften.
Nationale VersorgungsLeitlinie Chronische Herzinsuffizienz – Langfassung, 3. Aufl. Version 2. 2019 – Update 2020 [cited 2021 Jan 7].
- 2 Ponikowski P, Voors AA, Anker SD. et al 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891-975 . doi:10.1002/ejhf.592
- 3 Berliner D, Schneider N, Welte T. et al The Differential Diagnosis of Dyspnea. Dtsch Arztebl Int 2016; 113: 834-845 . doi:10.3238/arztebl.2016.0834
- 4 Haddad S, Wang Y, Galy B. et al Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure. Eur Heart J 2017; 38: 362-372 . doi:10.1093/eurheartj/ehw333
- 5 Hirsch VG, Tongers J, Bode J. et al Cardiac iron concentration in relation to systemic iron status and disease severity in non-ischaemic heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 22: 2038-2046 . doi:10.1002/ejhf.1781
- 6 Anker SD, Kirwan BA, van Veldhuisen DJ. et al Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 2018; 20: 125-133 . doi:10.1002/ejhf.823
- 7 Anker SD, Comin Colet J, Filippatos G. et al Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361: 2436-2448 . doi:10.1056/NEJMoa0908355
- 8 Ponikowski P, Kirwan BA, Anker SD. et al Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet 2020; 396: 1895-1904 . doi:10.1016/S0140-6736(20)32339-4
- 9 Lewis GD, Malhotra R, Hernandez AF. et al Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: The IRONOUT HF Randomized Clinical Trial. JAMA 2017; 317: 1958-1966 . doi:10.1001/jama.2017.5427
- 10 Olsson KM, Fuge J, Brod T. et al Oral iron supplementation with ferric maltol in patients with pulmonary hypertension. Eur Respir J 2020; 56
- 11 Jha MK, Qamar A, Vaduganathan M. et al Screening and management of depression in patients with cardiovascular disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73: 1827-1845 . doi:10.1016/j.jacc.2019.01.041
- 12 Schowalter M, Gelbrich G, Störk S. et al Generic and disease-specific health-related quality of life in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol 2013; 102: 269-278 . doi:10.1007/s00392-012-0531-4
- 13 Celano CM, Villegas AC, Albanese AM. et al Depression and anxiety in heart failure: a review. Harv Rev Psychiatry 2018; 26: 175-184 . doi:10.1097/HRP.0000000000000162
- 14 Kahl KG, Stapel B, Frieling H. Link between depression and cardiovascular diseases due to epigenomics and proteomics: Focus on energy metabolism. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89: 146-157 . doi:10.1016/j.pnpbp.2018.09.004
- 15 Angermann CE, Kaspar M, Marx A. et al A functional variant of the neuropeptide S receptor-1 gene modulates clinical outcomes and healthcare utilization in patients with systolic heart failure: results from the Interdisciplinary Network Heart Failure (INH) Study. Eur J Heart Fail 2017; 19: 314-323 . doi:10.1002/ejhf.706
- 16 Angermann CE, Ertl G. Depression, Anxiety, and Cognitive Impairment: Comorbid Mental Health Disorders in Heart Failure. Curr Heart Fail Rep 2018; 15: 398-410 . doi:10.1007/s11897-018-0414-8
- 17 Pina IL, Di Palo KE, Ventura HO. Psychopharmacology and Cardiovascular Disease. J Am Coll Cardiol 2018; 71: 2346-2359 . doi:10.1016/j.jacc.2018.03.458
- 18 Angermann CE, Gelbrich G, Störk S. et al Effect of Escitalopram on All-Cause Mortality and Hospitalization in Patients With Heart Failure and Depression: The MOOD-HF Randomized Clinical Trial. JAMA 2016; 315: 2683-2693 . doi:10.1001/jama.2016.7635
- 19 He W, Zhou Y, Ma J. et al Effect of antidepressants on death in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 2020; 25: 919-926 . doi:10.1007/s10741-019-09850-w
- 20 Angermann CE, Assmus B, Anker SD. et al Pulmonary artery pressure-guided therapy in ambulatory patients with symptomatic heart failure: the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). Eur J Heart Fail 2020; 22: 1891-1901 . doi:10.1002/ejhf.1943
- 21 Angermann CE, Störk S, Gelbrich G. et al Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail 2012; 5: 25-35 . doi:10.1161/CIRCHEARTFAILURE.111.962969
- 22 Frey A, Sell R, Homola GA. et al Cognitive Deficits and Related Brain Lesions in Patients With Chronic Heart Failure. JACC Heart Fail 2018; 6: 583-592 . doi:10.1016/j.jchf.2018.03.010
-
23
Frey A,
Homola GA,
Henneges C.
et al
Temporal changes in total and hippocampal brain volume and cognitive function in patients with chronic heart failure – The COGNITION.MATTERS-HF cohort study. Eur Heart J 2021
- 24 Berliner D, Hanselmann A, Bauersachs J. The Treatment of Heart Failure with Reduced Ejection Fraction. Dtsch Arztebl Int 2020; 117: 376-386 . doi:10.3238/arztebl.2020.0376
- 25 Seferovic PM, Ponikowski P, Anker SD. et al Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21: 1169-1186 . doi:10.1002/ejhf.1531
- 26 Störk S, Handrock R, Jacob J. et al Treatment of chronic heart failure in Germany: a retrospective database study. Clin Res Cardiol 2017; 106: 923-932 . doi:10.1007/s00392-017-1138-6
- 27 Bauersachs J. Heart failure drug treatment: the fantastic four. Eur Heart J 2021;
- 28 McMurray JJV, Packer M. How should we sequence the treatments for heart failure and a reduced ejection fraction? A redefinition of evidence-based medicine. Circulation 2020;
- 29 Adamson PB, Abraham WT, Bourge RC. et al Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail 2014; 7: 935-944 . doi:10.1161/CIRCHEARTFAILURE.113.001229
-
30 Beschluss des Gemeinsamen Bundesausschusses über die 11. Änderung der DMP-Anforderungen Richtlinie: Änderung der Anlagen 2 und 5, Ergänzung der Anlage 13 (DMP Herzinsuffizienz) und Anlage 14 (Herzinsuffizienz Dokumentation). Im Internet (Stand: 16.01.2021): https://www.g-ba.de/beschluesse/3299/
- 31 Ertl G, Angermann CE, Bekeredjian R. et al Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF-NETs) und Herzinsuffizienz-Einheiten („Heart Failure Units“, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. Kardiologe 2016; 10: 222-235 . doi:10.1007/s12181-016-0072-6
- 32 Gorodeski EZ, Goyal P, Cox ZL. et al Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America. J Card Fail 2020; 26: 448-456 . doi:10.1016/j.cardfail.2020.04.008