Symposium 18
3月28日［日］08:00-09:30
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Current status and future concern of non-pharmacological therapy to heart failure among super aging society
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急速に進行する超高齢社会は心不全パンデミックをもたらし、基礎疾患や表現型も10年前とはおきく様変わりしてきている。心不全の薬物治療には最近新しい進歩が見られているが、非薬物治療の充実ぶりもまた著しい。そのため、ガイドラインは毎年書き換えなくてはならぬほどの進展ぶりであるが、ガイドラインは残念なことに高齢者に特化した治療や高齢者に対する配慮、または高齢者には適さない治療などということは言及してくれない。このセッションでは心不全の非薬物治療について、以下の6つのテーマについて、議論を深めたいと思う。もちろん、私がここで書ききれなかった高齢者のテーマ（栄養、frail、リハビリとデバイス治療の関連など）についてもぜひ積極的にご応募いただきたい。
1. 植え込み型除細動器は高齢者に対してどの程度適用すべきか、費用対効果は？
2. 心房細動アブレーションは高齢者に対する心不全治療の中でどのように位置づけを考えるべきか？
3. TAVIの適応は何歳から、また何歳まで？
4. 僧帽弁や三尖弁に対するカテーテル治療は高齢者に対する福音となるのか？
5. Destination therapyの時代に植込型補助人工心臓治療はどこまで高齢者に適応可能か？
6. 末期心不全状態での侵襲的治療からの撤退を可能にする体制づくりとは？
The rapidly advancing super-aged society has brought about a pandemic of heart failure, and the etiologies and phenotypes have changed dramatically from 10 years ago. Although recent advances have been made in the pharmacological treatment of heart failure, development of the non-pharmacological treatment is also substantial. Accordingly, the guidelines are required to be up-dated almost every year, but unfortunately the guidelines neither mention about specific treatment or special care for the elderly, or treatments that are not suitable for the elderly. In this session, I would like to deepen the discussion on the following six themes regarding non-pharmacological treatment of heart failure. Of course, other important themes of elderly people that I could not describe here are welcome (nutrition, frail, rehabilitation in combination with device treatment, etc.).
1. How we indicate implantable cardioverter-defibrillator to elderly people? Is there any cost-effectiveness?
2. Does atrial fibrillation ablation have a crucial role in the treatment of heart failure for the elderly?
3. How old or how young should TAVR patients be?
4. Is catheter-based mitral/tricuspid plasty a gospel for the elderly?
5. To what extent can implantable ventricular assist device be applied to the elderly in the era of destination therapy?
6. How can we establish a system that enables withdrawal from invasive treatment in the end of life?
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Koichio Kinugawa
The Second Department of Internal Medicine, University of Toyama, Toyama
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JoAnn Lindenfeld
Cardiology, Vanderbilt University Medical Center, Nashville, USA
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JoAnn Lindenfeld
Cardiology, Vanderbilt University Medical Center, Nashville, USA
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Yuji Iwanami
Department of Cardiology, Nishiarai-Heart Center Hospital, Tokyo
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Toshiko Nakai
Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo
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Hiroshi Ueno
The Second Department of Internal Medicine, University of Toyama, Toyama
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Yuki Ishibashi
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki
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Osamu Seguchi
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita
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Tsuyoshi Suzuki
Department of Home-based Medical Care, Yumino Heart Clinic, Tokyo
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