The Future of Managing HF Patients Focus of Chatterjee Keynote

Advances in medications, devices and strategies have improved the outlook for patients with heart failure (HF). The advances promise even better outcomes, but their ultimate impact has been limited because concepts about HF and who has it have failed to keep pace. Lynne Warner Stevenson, MD, FACC, will offer new definitions for HF for the future when she delivers today's Kanu and Docey Chatterjee Keynote.

Stevenson, a professor of medicine and director of cardiomyopathy at Vanderbilt University Medical Center, will examine HF as it has been defined by congestion, ejection fraction, valvular regurgitation and ambulatory monitoring, as well as patient preferences for quality of life vs. length of life.

An advocate for narrowing the term "heart failure" from its current broad use, which discourages patients and providers, Stevenson will share her ideas for earlier identification and surveillance of patients with cardiomyopathies to prevent them from progressing to typical HF or needing advanced therapies.

When she entered the field 35 years ago, Stevenson cared for the first heart transplants patients at the University of California, Los Angeles, and later moved to Brigham and Women's Hospital and then to Vanderbilt. In those years, patients were told they only had six months to live.

Today, many patients are living for decades with their own hearts after a diagnosis of HF. After longer survival with good quality of life, however, the end of life is also prolonged, often with multiple comorbidities. She wants to ensure the next generation of specialists will be experts who bridge the spectrum of cardiomyopathies and therapies.

"This is not our mentors' heart failure anymore," Stevenson says. "It is their successes that have changed the landscape of HF and those who travel through it."

In her address, Stevenson also will explore the importance of personalization of care and greater involvement of patients in their care. For cardiomyopathy and HF, personalization will arise at the junction of precision medicine and patient preferences along their journey, she says.

Multidimensional precision is now conceivable with the development of biorepositories and electronic health records, but realization is lagging far behind the anticipation.

The empowerment of patients to monitor their physiology and re-direct their journeys will evolve in partnership with providers, she explains.

Technology may render the standard office visit a diminishing part of the relationship, which will require a broader team to integrate care for comorbidities such as diabetes, lung, kidney and liver disease. A looming hurdle is how to elicit equal engagement of patients from disadvantaged demographics who traditionally are less integrated into health care.

"I hope that providers who have seen HF for many years can open a different lens to see how their patients differ from those who came 10, or even five, years ago, and redesign care to match," Stevenson said, adding that she had the good fortune to visit Kanu Chatterjee's clinic in San Francisco. "His legacy for the future includes a vital physiologic principle. However, he also taught us by example that no matter how we define the diseases, no matter how quality of care is counted, the patients who come will meet us one at a time."

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