Heart failure remains one of the top causes of morbidity and mortality accounting for 1 in 9 deaths, according to CDC data.
Heart failure is a serious condition that happens when the heart cannot pump enough blood and oxygen to support other organs in the body. It can affect the left ventricle, right ventricle, or both.
Certain diseases, such as coronary heart disease, diabetes, or high pressure can increase the risk for heart failure, as well as unhealthy behaviors including smoking tobacco, eating foods high in fat, cholesterol, and sodium, inadequate physical activity, or being obese.
Taking your medicines can help manage heart failure symptoms or prevent the condition from getting worse. Most commonly used medications are diuretics that can help get rid of excess fluid and relieve swelling and shortness of breath, and ACE inhibitors that have relaxing effect on the arteries and reduce the amount of work the heart has to do to pump blood around the body.
People with heart failure are also advised to track their symptoms each day so that they can discuss any change with their healthcare team. Early diagnosis and treatment of heart failure are key factors that can improve quality and length of life for people who have this condition.
The ejection fraction (EF) is an important measurement in diagnosing and tracking heart failure and in determining how well one's heart is pumping out blood. It is a percent measurement of how much blood the left ventricle pumps out with each contraction.
For example, an ejection fraction of 70% means that 70% of the total amount of blood in the left ventricle is pushed out with each heartbeat.
A normal heart's ejection fraction may be between 50% and 70%. A measurement of under 40% may indicate heart failure or cardiomyopathy, while ejection fraction higher than 75% may be evidence of the other heart condition such as hypertrophic cardiomyopathy.
A significant number of patients with heart failure happen to have a normal ventricular ejection fraction during echocardiography examination. Previously known as diastolic heart failure, it is now referred to as heart failure with preserved ejection fraction (HFpEF). It happens when the heart muscle contracts normally but the ventricles do not relax as they should during ventricular filling or when the ventricles relax.
Another type of heart failure is heart failure with reduced ejection fraction (HFrEF), also referred to as systolic heart failure, which occurs when the heart muscle does not contract effectively and, as a result, pumps less oxygen-rich blood out to the body.
The etiology and treatment of HFpEF and HFrEF are significantly different and it can be challenging to healthcare providers when deciding how to treat each condition.
Last year (2017), the American College of Cardiology (ACC) released new heart failure guidelines with revised terminology from the old systolic and diastolic heart failure to heart failure with preserved (HfpEF) and reduced (HFrEF) ejection fraction and updated evidence on the role of certain medications in the treatment of HFrEF.
The ACC has been also developing some amazing apps with the goal to bring the evidence-based guidelines and tools to smartphones and tablets.
The latest addition to the list of these outstanding ACC's apps is TreatHF app which is designed for use by clinicians to help optimize pharmacological therapy for chronic symptomatic heart failure patients with reduced ejection fraction (HFrEF), specifically for stage C patients.
The advice in this app is derived from either 2013 ACC/AHA/HFSA Heart Failure Guideline and 2017 Guideline updates, or 2017 ACC's Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment, which only serves as a starting point.
The use of TreatHF app assumes that clinicians would conduct a full evaluation of the patient, consult relevant medical specialists as needed, utilize a team-based approach to optimize the treatment, and consider patient preferences regarding therapeutic options after discussion with them.
The app is intended to support clinical decisions, not to represent the only or best course of care, or to replace clinical judgment.
Upon opening the TreatHF app, you would probably notice that the app has the same interface as the rest of ACC apps.
There are three sections located at the top of the screen, including Evaluation, Advice (which is empty until some data is added), and Therapies.
Providers start on Evaluation page by selecting NYHA Class and LVEF Range and entering patient's data, including current use of medications (RAS inhibitors, beta blockers, and diuretics) and potential indications/contraindications to other medications or treatments.
The app provides tailored advice for adjusting current medication, as well as additional medication doses, and other specific evidence-based treatments for the patient, in a form of a summary based on entered indications.
Clinicians have the option either print or email a summary of the advice, and view more detailed information on the use of each therapy by tapping on View More Instructions links in the summary or in the Therapies section of the app.
At the bottom of the screen, there are four more sections, including Resources containing patient and clinicians resources, tools, and references, Terms, About the App, and News section which is supposed to provide the latest research and articles, as well as updates on related ACC guidelines and tools. The News section, however, currently does not provide any news or articles.
Overall, TreatHF app is another amazing app coming from ACC, designed for all providers who treat patients with heart failure with reduced ejection fraction (HFrEF). It is based on the latest guideline and current evidence-based studies to assist clinicians in choosing the most effective treatments for their patients.
It would be even better tho if the app also includes recommendations for patients with preserved ejection fraction (HFpEF), which would make it truly comprehensive resource and decision support for heart failure.
Benefit: Any provider who treats or manages patients with HFrEF should have this app