LVAD Therapy Versus Medical Management in Heart Failure: An Integrative Review

Background: Advancements in technology have increased management options for heart failure (HF) patients. Options include guideline-directed medical therapy (GDMT), left ventricular assist device (LVAD) therapy, and/or heart transplant. Due to resource allocations, the most accessible options for many HF patients include GDMT and LVAD therapy. Authors of this integrative review (IR) sought to examine quality of life (QOL) and hospitalization rate outcomes among patients receiving GDMT versus LVAD therapy. Methods: 417 articles were screened across multiple databases (CINAHL, Medline, ProQuest, Ovid, PubMed) for inclusion into the integrative review based on inclusion criteria: published within five years, peer-reviewed, written in English, considered adults ages ≥ 18, and considered patients with NYHA HF classification stages III-IV. In total, 13 articles were appraised and thematically analyzed. Results: IR findings were presented according to identified themes. Results showed that LVAD therapy poses unique risks: social limitations, higher risk for adverse events, and higher hospitalization rates. Results demonstrated that both GDMT and LVAD therapy improve the following outcome measures in HF patients: survivability, QOL, and functional capacity. It was noted among articles discussing GDMT that combination GDMT has superior outcomes when compared to solo GDMT. Limited research was available that directly compared GDMT and LVAD outcomes. Limited research was available surrounding GDMT outcomes. Conclusions: While effective, LVAD therapy for HF patients incurs greater complication risk when compared to GDMT. Both GDMT and LVAD therapy improve QOL, functional capacity, and survivability among HF patients. More research is warranted regarding direct comparisons between LVAD and GDMT outcomes

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery