New international guidelines for heart transplant candidates standardize patient care

ISHLT publishes guidelines for global heart patient management

The International Society for Heart and Lung Transplantation (ISHLT) announces the release of the first international guidelines for heart failure patient management, particularly prior to heart transplantation, published in this month's edition of the Journal of Heart and Lung Transplantation (September 2006). For the first time, comprehensive international guidelines will help bridge the gap where current principles fall short and provide guidance to practicing physicians and cardiologists around the world.

Heart failure is a serious condition in which the heart is unable to pump enough blood through the body. Based on statistical data from the National Heart Lung Blood Institute and other sources, it is estimated that at least 100 million people around the world suffer with heart failure with about 12 million new cases each year.

Over the past decade, advancements in patient care with ventricular assist and other implantable devices, stem cell implants, biomedical developments and improved pharmaceutical management, have had a dramatic impact on care for heart failure patients. Taking these and other advancements into consideration, the new guidelines underscore the optimal process for managing heart failure patients prior to considering transplantation.

"The new guidelines will enhance the effectiveness of patient care, optimize patient outcomes, and improve the overall cost of patient care by focusing resources on the most effective strategies," said Mariell Jessup, M.D., ISHLT task force chair and Professor of Medicine at the University of Pennsylvania.

"Our goal is to reach cardiologists and other physicians around the globe who don't currently have resources available to help treat their patients suffering with advanced heart failure," said Edoardo Gronda, M.D., ISHLT task force chair and Director of Clinical Cardiology and Heart Failure Unit, Istituto Clinico Humanitas, Milan, Italy. "In turn, we are working to help standardize treatment for patients regardless of where they are located."

Recognizing a need for standardized treatment around the globe, ISHLT initiated a review process more than two years ago, establishing a series of task forces utilizing a diverse group of its members who are active in heart failure and transplant medicine. The task forces reviewed criteria for placing patients on waiting lists for donor organs as well as pharmacological, surgical and device-based intervention to successfully bridge patients to transplant.

International collaboration within ISHLT made possible a global perspective that takes into consideration the barriers to transplantation in different countries, reviewing varied healthcare systems and economic factors that influence medical care for heart-failure patients.

"While there are several agencies worldwide that review and address guidelines for treatment and management of heart failure in patients, none are comprehensive," explained Mandeep Mehra, M.D., University of Maryland School of Medicine and ISHLT task force chair. "With our international membership, ISHLT is in the ideal position to advocate comprehensive guidelines for the global medical community."

A Comprehensive International Approach

To develop the new guidelines, ISHLT convened three international task forces to examine particular areas of consideration in heart failure patient management. Each task force consisted of an international mix of society members charged with reviewing and deliberating specific issues of importance to heart failure patient management. The final recommendations of the task forces were reviewed by a blinded, independent, international editorial review board and then presented to the ISHLT board of directors for approval.

Revisiting Listing Criteria for Heart Transplantation

The first task force, charged with Revisiting Listing Criteria for Heart Transplantation, produced a report particularly focused on patient outcomes. This task force, working to balance societal needs with individual patient needs, presented a clear consensus on how to allocate the finite resources available, meaning the finite number of donor organs available for transplant.

Optimal Pharmacological and Non-Pharmacological Management Of Cardiac Transplant Patients

The second task force focused on Optimal Pharmacological and Non-pharmacological Management of Cardiac Transplant Patients and approaches to be considered prior to transplant evaluation. The recommendations acknowledge the goal to reduce the death rate of patients while waiting for transplantation and identifies the need to provide the best available medical therapy prior to consideration for transplant. The task force outlines the necessary steps to follow prior to recommending a patient for transplantation, but also explores how to avoid transplantation, including the possible role of investigational drug therapies in delaying or avoiding transplant. Finally, this task force's report emphasizes the need for end-of-life discussions with all patients facing advanced heart failure.

Heart Rhythm Considerations In Heart Transplant Candidates and Considerations For Ventricular Assist Devices

The third task force examined Heart Rhythm Considerations in Heart Transplant Candidates, particularly studying the role of ventricular assist devices in transplantation. This task force's report outlines the critical role of device-based therapy, including pacemakers and defibrillators, for patients with heart failure under consideration for heart transplant.

Overall, the new guidelines provide a succinct template for any cardiologist or practicing physician around the world who may refer patients for heart transplants.

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About ISHLT

The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit organization dedicated to the advancement of the science and treatment of end-stage heart and lung diseases. Created in 1981, the Society now includes more than 2,200 members from 45-plus countries, representing a variety of disciplines involved in the management and treatment of end-stage heart and lung disease.

ISHLT maintains two vital databases. The International Heart and Lung Transplant Registry is a one-of-a-kind registry that has been collecting data since 1983 from 223 hospitals from 18 countries. The ISHLT Mechanical Circulatory Device (MCSD) database has been collecting data since 2002 with the aim of identifying patient populations who may benefit from MCSD implantation; generating predictive models for outcomes; and assessing the mechanical and biological reliability of current and future devices. For more information, visit www.ishlt.org.


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