Reducing 30-day Rehospitalization for Heart Failure: An Attainable Goal?
|
|
- Joanna Douglas
- 5 years ago
- Views:
Transcription
1 Reducing 30-day Rehospitalization for Heart Failure: An Attainable Goal? Ileana L. Piña, MD, MPH Professor of Medicine, Epi/Biostats Case Western Reserve University Graduate VA Quality Scholar Cleveland Ohio
2 If we want to work with a system to influence its direction -- a normal desire as we work with human organizations--the place for us to work is deep in the dynamics of the system where [its] identity is taking form. Wheatley & Kellnor-Rogers, 1996
3 Contemporary Application of Evidence-based Care for Acute and Chronic Heart Failure Heart failure results in substantial morbidity and mortality Fortunately, a number of evidence-based, life-prolonging drug and device therapies have been developed and are now widely available for managing patients with heart failure Despite overwhelming clinical-trial evidence, expert opinion, national guidelines, and a vast array of educational conferences, these evidence-based, life-prolonging drug and device therapies continue to be underutilized in both the inpatient and outpatient settings Fonarow GC. Rev Cardiovasc Med. 2002;3:S2-S10.
4 Definition of Quality Degree to which health care services increase the likelihood of desired health outcomes and are consistent with current professional knowledge Are you doing the right things? Are your patients better off for it?
5 Challenges in Measuring HF Quality of Care HF is not a single entity Systolic vs diastolic HF Etiology (ischemic vs other) Severity (NYHA class I-IV) Limited data on what processes works, particularly in the acute setting Even less information how process of care delivery factors affect outcomes Longitudinal disease Yet measurement often cross-sectional
6 Heart failure readmission rates are quite high. Almost half of the patients were readmitted within 6 months
7
8 Heart Failure is the most common reason for 30 day reshospitalization Copyright CWRU-CME 2003 All Rights Reserved n Jencks et al. N Engl J Med 2009;360:
9 Copyright CWRU-CME 2003 All Rights Reserved
10
11 Copyright CWRU-CME 2003 All Rights Reserved
12 Heart failure 30-day Risk-Standardized Readmission Rate Distribution Krumholz, H. M. et al. Circ Cardiovasc Qual Outcomes 2009;2:
13 ADHERE Variation in ACE Inhibitor Use for HF Rate (%) ORYX Core Measure: HF 3 - LVEF < 40% prescribed ACEI at discharge ADHERE Hospitals ADHERE: Dec 2002, 206 Hospitals; 23,193 patients (subset with LVEF.40, no CI) Fonarow GC et al. Arch Intern Med. 2005;165:
14 Outcomes in Patients Hospitalized With HF 100 Hospital Readmissions 100 Mortality % 50% % 33% 50% 0 30 Days 6 Months 0 30 Days 12 Months 5 Years Mean LOS: 6.5 days Fonarow, GC. Rev Cardiovasc Med. 2002;3(suppl 4):S3 Jong P et al. Arch Intern Med. 2002;162:1689 Annual mortality rate- NYHA class III HF- 12% [COPERNICUS DATA] NYHA class II HF- 7% [SCD-HeFT DATA]
15 HF readmission can be decreased. Comprehensive discharge planning plus postdischarge support for older patients with CHF significantly reduced readmission rates and may improve health outcomes such as survival and QOL without increasing costs.
16
17
18 52% of heart failure patients are not seen in the first 30 days after a hospitalization Copyright CWRU-CME 2003 All Rights Reserved n Jencks et al. N Engl J Med 2009;360:
19 Why Does it Matter to Providers? Putting the patient first Improving transitions of care The right treatment at the right time for the right reason for all patients Fulfilling requirements Finding opportunities to improve care Use measurement as a tool to create an imperative to improve and provide perspective regarding performance Clinicians should engage constructively in this effort and should examine adverse outcomes within their institutions
20 Cumulative Impact of Heart Failure Therapies Relative-Risk 2 Year Mortality None % ACE Inhibitor 23% 27% Aldosterone Ant 30% 19% Beta-Blocker 35% 12% CRT +/- ICD 36% 8% Cumulative risk reduction if all four therapies are used: 77% Absolute risk reduction: 27%, NNT = 4 Updated from Fonarow GC. Rev Cardiovasc Med. 2000;1:25-33.
21 Is it omission, or commission in the hospital stay????? Inadequate diuresis without other considerations? Removal of life-saving therapies? Fear of hypotension, renal dysfunction? Avoiding phone calls? No uptitration Late visits
22
23 Source: Wall Street Journal
24 Clinical Status at Discharge Evidence for Incomplete Relief from Congestion 35 32% Asymptomatic 44% Improved (but still symptomatic) 40% % % 7% 13% 11% 3% 2% No Mention 11% 0 (<-20) ( 20 to 15)(-15 to 10)( 10 to 5)( 5 to 0) (0 to 5) (5 to 10) (>10) Change in Weight (lbs) Fonarow GC. Rev Cardiovasc Med. 2003; 4 (Suppl. 7): 21
25 Medication Change Analysis CHRONICLE CONTROL Changes / Patient Month p= p= p< All Drugs All CV Drugs Diuretics ACE/ARB Beta Blockers Vasodilators/ Nitrates
26 Large Treatment Gaps for Newer Guideline 2 Recommended Therapies Including ICD Baseline Q1 Q2 Q3 Q4 Years 2005 to 2006 P= P= P< Aldosterone Antagonist Hyd/Nitrates in Black Pts ICD in LVEF <= 30% Data from 97 GWTG-HF hospitals and 18,516 HF patients were collected from 1/05-3/06 Fonarow GC et al. AHA 2006 abstract
27 Variation in HF Quality of Care in US Cardiology Practices: IMPROVE-HF The frequency distribution of conformity rates by practice Use of Hydralazine/Nitrates in Black Patients Median, 0.0 Mean, 7.3 Yancy CW et al. HFSA 2008 abstract
28 Mean Dose and Frequency of Dose Changes 2 of β-blockade Post HF Hospital Discharge 8 Mean Daily Dose (mg) At Discharge At day Follow-up Carvedilol 17.8 ± ± 17.3 Newly started on carvedilol 12.5 ± ± 15.2 Metoprolol succinate 68.3 ± ± 52.2 Newly started on metoprolol succinate Immediate-release metoprolol tartrate 57.5 ± ± ± ± 56.4 Atenolol 43.7 ± ± 37.8 Fonarow GC, et al. Am J Cardiol 2008;102:1524-9
29 Continuity of HF Care Reliable Care: Not Missing the Steps Hospital ED Diagnosis Admit CCU? Acute Rx Evaluation CCU Telemetry IV Meds Oral Meds LV function Echo and/or Cath? Other Evaluation Tx to Floor DC Black hole* Oral Meds Other Rx? Other eval Pt Ed F/U Disease Manage Early Post DC Right meds? Titration Pt Education Disease Manage Continuity Device? Black hole* Outpatient On right meds? On right dose? Volume status Re-assess EF Device? Self Manage? Other Issues? Fonarow GC. Rev Cardiovasc Med. 2006;7:S3-11. * Who is responsible????
30 The Perilous Time 40% of HF patients do not get discharged to home Skilled Nursing Facility Long Term Care Rehabilitation Facility Home discharge Hospital Home Visiting Nurse Home physician visits Timing to next decompesation
31 Causes of Hospital Readmission for Congestive Heart Failure Over 2/3 of HF Hospitalizations Preventable Diet Noncompliance 24% Rx Noncompliance 24% 16% Inappropriate Rx 19% Failure to Seek Care 17% Other Post d/c monitoring Annals of Internal Medicine 122:415-21, 1995
32 Patient or Clinician driven
33 Home visits Home based nursing with special training in HF
34 Efficacy of Heart Failure Management Programs Stewart S, et al. Circulation 2002;105:2861 Copyright CWRU-CME 2003 All Rights Reserved
35 6-Month All Cause Mortality Rates by Randomization Arm Alere Standard Care 60% 50% All-cause mortality 40% 30% 20% p= % 0% 11.2% 7.0% Days After Study Entry
36 Understanding health care as a system How we improve what we make What society needs How we create, make health care
37 Tools are critical Aid to practitioners to apply best care Making tools attractive by not adding more work Non threatening Easily integrated into the current practice Need to understand better the barriers that exist to implement quality measures Promoted by physician champions
38 The Heart Failure Continuum A successful care process must address ALL areas of heart failure care SNF care Ambulatory clinic care ED decisions to send Home health care when discharged home Goals: Decrease hospitalizations Decrease length of stay Improve QOL Prolong survival Improve symptoms Copyright CWRU-CME 2003 All Rights Reserved
39 Integration Of The Care Process Hospital, clinic, referring MD Flow of information Flow of information HF team Communication Flow of information HF patient Copyright CWRU-CME 2003 All Rights Reserved
40 HF GWTG-HF Cycle of Quality Improvement Find and Support a Champion HEART FAILURE Assess HF Treatment Rates Measure current treatment rates and process-of-care indicators Implement Refined Protocols Hospital team coordinates implementation of refined protocols Evaluate Assessment Hospital team reviews summary reports and current protocols Refine Protocols Hospital team identifies areas for improvement
41 A Call to Action Care about core measures, performance measures, and outcomes! Get involved with the development of the measures know what it means for you Understand what is required of you to meet performance measures Document your adherence to guidelines/pm Find opportunities for improvement Demonstrate to your patients that you have quality outcomes
42 What is H2H? National Rallying Point Catalyze Action Leverage Other Initiatives Rapid Learning Community Building on Success
43 Hospital to Home (H2H) A national quality improvement initiative of the American College of Cardiology and the Institute for Healthcare Improvement Building on Success ACC s Door to Balloon: An Alliance for Quality IHI s 100K Lives & 5M Lives Campaigns
44 Goal Reduce 30 day, all-cause, risk standardized readmission rates (RSRR) for patients discharged with cardiac conditions by 20% by December 2012.
45 H2H Core Concepts Post-discharge medication management. Patients must not only have access to the proper medications, they need to be properly educated on how to use them. Early follow-up. Discharged patients should have a followup visit scheduled within a week of discharge, as well as the means of getting to that appointment. Symptom management. Patients must recognize the signs and symptoms that require medical attention, as well as the appropriate person to contact if those signs/symptoms appear.
46
47
48
49
50
51 Copyright CWRU-CME 2003 All Rights Reserved
52 Hospitals and clinicians have no way to assess and benchmark overall clinical performance from the patient s perspective. Krumholz and Normand, Circ 2008 After all..isn t it all about the PATIENT?
Designing Systems for Effective Heart Failure Care
Designing Systems for Effective Heart Failure Care Ileana L. Piña, MD, MPH Professor of Medicine, Epidemiology and Population Health Albert Einstein College of Medicine Associate Chief of Cardiology for
More informationDisclosures. Preventing Heart Failure Re-admissions in Deaths Due to Cardiovascular Disease (United States: ) Heart Failure
29 th Annual Cardiology for Clinicians Spring Symposium Workshop #3 Alumni Hallway, Northeastern Conference Room, 1-9525 Thursday, May 5, 2016 Preventing Heart Failure Re-admissions in 2016 Leway Chen,
More informationThe Role of Information Technology in Disease Management: A Case for Heart Failure
The Role of Information Technology in Disease Management: A Case for Heart Failure Teresa De Peralta, MSN, APN-C Heart Failure Product Workflow Consultant Medtronic Population Management Level 3: As patient
More informationImplementing the CardioMEMS HF System into the Management of Heart Failure Patients
Implementing the CardioMEMS HF System into the Management of Heart Failure Patients Robert W. Hull MD FACC Associate Professor of Medicine WVU Heart Institute Co-director, Arrhythmia Service Director,
More informationKeynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes?
Keynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes? 24 th Annual San Diego Heart Failure Symposium June 1-2, 2018 La Jolla, CA Barry Greenberg, MD Distinguished Professor
More information2016 Update to Heart Failure Clinical Practice Guidelines
2016 Update to Heart Failure Clinical Practice Guidelines Mitchell T. Saltzberg, MD, FACC, FAHA, FHFSA Medical Director of Advanced Heart Failure Froedtert & Medical College of Wisconsin Stages, Phenotypes
More informationESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Patients t with acute heart failure frequently develop chronic heart failure Patients with chronic heart failure frequently decompensate acutely ESC Guidelines for the Diagnosis and A clinical response
More informationHF QUALITY MEASURES. Hydralazine/nitrate at discharge: Percent of black heart
Get With The Guidelines - Heart Failure is the American Heart Association s collaborative quality improvement program, demonstrated to improve adherence to evidence-based care of patients hospitalized
More informationSummary/Key Points Introduction
Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification
More informationThe role of remote monitoring in preventing readmissions after acute heart failure
The role of remote monitoring in preventing readmissions after acute heart failure October 20, 2017 Randall C Starling MD MPH FACC FAHA FESA FHFSA Professor of Medicine Kaufman Center for Heart Failure
More informationImproving Outcomes After Hospital Discharge: How To Do It and What is the Evidence That it Works?
UCSD Heart Failure Symposium Improving Outcomes After Hospital Discharge: How To Do It and What is the Evidence That it Works? Gregg C. Fonarow, MD, FACC, FAHA, FHFSA The Eliot Corday Professor of Cardiovascular
More informationMEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION
MEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION FRANCIS X. CELIS, D.O. OPSO FALL CONFERENCE PORTLAND, OR 16 SEPTEMBER 2017 OVERVIEW What are the ACC/AHA Stages of HF? What
More informationThe Failing Heart in Primary Care
The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and
More informationChronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update)
Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update) NICE guideline Apendix C The algorithms Draft for consultation, January 2010 Chronic
More informationClinical Pathways Heart Failure Webinar AMGA May
Clinical Pathways Heart Failure Webinar AMGA May 31 2016 Randall C. Starling, MD, MPH, FACC,FESC Professor Of Medicine Heart Failure and Cardiac Transplant Medicine Heart and Vascular Institute Cleveland
More informationHEART FAILURE QUALITY IMPROVEMENT. American Heart Association Shawni Smith Regional Director, Quality & Systems Improvement
HEART FAILURE QUALITY IMPROVEMENT American Heart Association Shawni Smith Regional Director, Quality & Systems Improvement 1 DISCLOSURES NONE 2 3 WHY IS THIS IMPORTANT? WHY? Heart Failure Currently, an
More informationFINANCIAL DISCLOSURE: No relevant financial relationship exists
The Value of Guideline Directed Medical Therapy in Heart Failure Steve Dentel RN BSN CPHQ National Director, Field Programs and Integration American Heart Association/American Stroke Association FINANCIAL
More informationOptimal Implementation of Heart Failure Guidelines and Standards Gregg C. Fonarow, MD, FACC, FAHA
Optimal Implementation of Heart Failure Guidelines and Standards Gregg C. Fonarow, MD, FACC, FAHA Eliot Corday Professor of Cardiovascular Medicine and Science UCLA Division of Cardiology Director, Ahmanson-UCLA
More information1000 Lives Key Components of Reliable, Evidence-Based Chronic Heart Failure Care how do we compare?
1000 Lives Key Components of Reliable, Evidence-Based Chronic Heart Failure Care how do we compare? Dr Nerys Davies, GPST Ms B. Davies, Specialist Nurse (Heart Failure) Dr J. Taylor, Consultant Cardiologist
More informationHeart Failure Guidelines For your Daily Practice
Heart Failure Guidelines For your Daily Practice Juan M. Aranda, Jr., MD, FACC, FHFSA Professor of Medicine Director of Heart Failure and Cardiac Transplantation University of Florida College of Medicine
More informationCASE STUDIES IN ADVANCED HEART FAILURE
CASE STUDIES IN ADVANCED HEART FAILURE Navin Rajagopalan, MD Director, Congestive Heart Failure Medical Director, Cardiac Transplantation Gill Heart Institute, Cardiovascular Medicine DISCLOSURES NOTHING
More informationWhere Does the Wearable Cardioverter Defibrillator (WCD) Fit In?
Where Does the Wearable Cardioverter Defibrillator (WCD) Fit In? 24 th Annual San Diego Heart Failure Symposium June 1-2, 2018 La Jolla, CA Barry Greenberg, MD Distinguished Professor of Medicine Director,
More informationUnderstanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials -
Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials - Clinical trials Evidence-based medicine, clinical practice Impact upon Understanding pathophysiology
More informationBeta-blockers in heart failure: evidence put into practice
Beta-blockers in heart failure: evidence put into practice John McMurray Professor of Medical Cardiology, University of Glasgow & Consultant Cardiologist,Western Infirmary, Glasgow, UK Eugene Braunwald
More informationCardiovascular Guideline-Driven Pharmacotherapies: Optimizing Management
Cardiovascular Guideline-Driven Pharmacotherapies: Optimizing Management David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management
More informationHeart Failure. Jay Shavadia
Heart Failure Jay Shavadia Definition Clinical syndrome characterized by: Symptoms: breathlessness at rest or on exercise, fatigue, tiredness or ankle swelling AND Signs: tachycardia, tachypnea, pulmonary
More informationDisclosures. Overview. Goal statement. Advances in Chronic Heart Failure Management 5/22/17
Disclosures Advances in Chronic Heart Failure Management I have nothing to disclose Van N Selby, MD UCSF Advanced Heart Failure Program May 22, 2017 Goal statement To review recently-approved therapies
More informationDisclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017
Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies
More informationRisk Stratification of Sudden Cardiac Death
Risk Stratification of Sudden Cardiac Death Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: None Sudden Cardiac Death A Major Public Health Problem > 1/2 of
More informationHeart Failure. Disclosures. Objectives: 8/28/2017. This is not a virus. It doesn t go away. none
Heart Failure This is not a virus. It doesn t go away Shelley Wojtaszczyk, FNP-C, CHFN Heart Failure Program Coordinator Mercy Hospital of Buffalo none Disclosures Objectives: Defining and identifying
More informationA Global perspective on Heart Failure: What needs to change? Martin R Cowie London, United Kingdom
A Global perspective on Heart Failure: What needs to change? Martin R Cowie London, United Kingdom Global perspective on heart failure: what needs to change? Martin R Cowie Professor of Cardiology National
More informationHeart Failure Management: Continuum of Care
Healthy Kingsport Conference Heart Failure Management: Continuum of Care Robin Harris PhD, ANP-BC, ACNS-BC Clinical Assistant Professor University of Tennessee College of Nursing Important Info I, Robin
More informationVentricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation Objectives Current rationale behind use of MCS Patient Selection Earlier?
More informationTreating HF Patients with ARNI s Why, When and How?
Treating HF Patients with ARNI s Why, When and How? 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La Jolla, CA Barry Greenberg M.D. Distinguished Professor
More informationManagement of Acute Heart Failure
Management of Acute Heart Failure Uri Elkayam, MD Professor of Medicine University of Southern California School of Medicine Los Angeles, California elkayam@usc.edu ADHF Treatments Goals.2 Improve symptoms.
More informationTỐI ƯU HOÁ ĐIỀU TRỊ SUY TIM MẠN PGS. TS. CHÂU NGỌC HOA ĐHYD TPHCM
TỐI ƯU HOÁ ĐIỀU TRỊ SUY TIM MẠN PGS. TS. CHÂU NGỌC HOA ĐHYD TPHCM Signed by HFA / ESC/ HFSA/ ACC/ AHA Downloaded from http://circ.ahajournals.org/ at Amgen, Inc-- on May 20, 2016 3 In the year 2016, by
More informationGet With The Guidelines: Lessons for National Healthcare Improvement Programs
Get With The Guidelines: Lessons for National Healthcare Improvement Programs Gregg C. Fonarow, MD, FACC, FAHA, FHFSA Eliot Corday Professor of Cardiovascular Medicine and Science UCLA Division of Cardiology
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationICD Therapy. Disclaimers
ICD Therapy Rodney Horton, MD Texas Cardiac Arrhythmia Institute Texas Cardiovascular, PA Austin, TX Speaker s Bureau St. Jude Medical Medtronic Boston Scientific Disclaimers Clinical Advisory Panel St.
More informationThe Approach to Patients with Heart Failure and Mid-Range (40-50%) Ejection Fraction (HFmrEF)
The Approach to Patients with Heart Failure and Mid-Range (40-50%) Ejection Fraction (HFmrEF) 22 nd Annual Heart Failure 2018 an Update on Therapy April 21, 2018 Los Angeles, CA Barry Greenberg, M.D. Distinguished
More informationCT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD
CT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD Clinical syndrome resulting from a structural or functional cardiac disorder that impairs the ability of the heart to
More informationNew Advances in the Diagnosis and Management of Acute and Chronic Heart Failure
New Advances in the Diagnosis and Management of Acute and Chronic Heart Failure Deborah Budge, MD Intermountain Healthcare Heart Failure Cardiologist Objectives: State the updates from the ACC 2013 HF
More informationHeart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist
Heart Failure Management Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart failure prevalence is expected to continue to increase¹ 21 MILLION ADULTS WORLDWIDE
More informationDISCLOSURES ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION NONE
ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION Lori M. Tam, MD Providence Heart Institute DISCLOSURES NONE 1 OUTLINE Systolic vs. Diastolic Heart Failure New
More informationManagement of Heart Failure: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians
Performance Measurement Management of Heart Failure: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing Committee Amir Qaseem, MD,
More information3/2/2017. Identifying the Patient for Advanced Therapies. Why is Identifying the Adv HF patient important? CHF Stages and Steps of Treatment
Identifying the Patient for Advanced Therapies Cindy Bither Chief NP- Adv HF Program Medstar Heart and Vascular Institute Stage A High risk with no symptoms Stage B Structural heart disease, no symptoms
More informationAll Roads Lead to HF. Presenter Disclosure Information. After a Decade of (Almost) Nothing Multiple New Therapies for Heart Failure CAD.
After a Decade of (Almost) Nothing Multiple New Therapies for Heart Failure Larry A. Allen, MD, MHS Director for Advanced Heart Failure October 18, 2016 Presenter Disclosure Information I will not discuss
More informationESC Guidelines for diagnosis and management of HF 2012: What s new? John Parissis, MD Athens, GR
ESC Guidelines for diagnosis and management of HF 2012: What s new? John Parissis, MD Athens, GR Disclosures ALARM INVESTIGATOR RESEARCH GRANTS BY ABBOTT USA AND ORION PHARMA The principal changes from
More information9/10/ , American Heart Association 2
Clyde W. Yancy, MD, MSc, MACC, FAHA, MACP Vice Dean, Diversity & Inclusion Magerstadt Professor of Medicine Professor of Medical Social Sciences Chief, Division of Cardiology Northwestern University, Feinberg
More informationREVIEW ARTICLE. Sacubitril/valsartan Use for the Hospitalist Mitchell Padkins 1, James Hart 1, Rachel Littrell 2
Sacubitril/valsartan Use for the Hospitalist Mitchell Padkins 1, James Hart 1, Rachel Littrell 2 1 University of Missouri School of Medicine, Columbia, MO 2 Division of Cardiovascular Medicine, Department
More informationTherapeutic Targets and Interventions
Therapeutic Targets and Interventions Ali Valika, MD, FACC Advanced Heart Failure and Pulmonary Hypertension Advocate Medical Group Midwest Heart Foundation Disclosures: 1. Novartis: Speaker Honorarium
More informationEstimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches
Heart Failure: Management of a Chronic Disease Jenny Bauerly RN, CHFN, APRN-BC Heart Failure (HF) Definition A complex clinical syndrome that can result from any structural or functional cardiac disorder
More informationHeart Failure Dr Eric Klug Sunninghill, Sunward Park, CM Johannesburg Academic Hospital
Heart Failure 2012 Dr Eric Klug Sunninghill, Sunward Park, CM Johannesburg Academic Hospital PRELOAD COWS Reduction in milk production INOTROPY & HEART RATE AFTERLOAD DISTRIBUTION NETWORK THE CLASSIC APPROACH
More informationBiomarkers in the Age of Sacubitril/Valsa rten: Has the PARADIGM Changed
Biomarkers in the Age of Sacubitril/Valsa rten: Has the PARADIGM Changed Alan S. Maisel MD FACC Professor of Medicine, University of California, San Diego, Director, CCU and Heart Failure Program San Diego
More informationOutline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan
New Pharmacological Therapies for Heart Failure Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center
More informationST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective
ST2 as a Cardiovascular Biomarker Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Coronary Care Unit University of California, San Diego ST2 and IL-33: Cardioprotective ST2: member of the
More informationHeart Failure 101 The Basic Principles of Diagnosis & Management
Heart Failure 101 The Basic Principles of Diagnosis & Management Bill Tran, MD Non Invasive Cardiologist February 24, 2018 What the eye does not see and the mind does not know, does not exist. DH Lawrence
More informationBiomarker-guided HF: What have we learned (so far)?
Biomarker-guided HF: What have we learned (so far)? James L. Januzzi, Jr, MD, FACC, FESC Associate Professor of Medicine Harvard Medical School Director, Cardiac ICU Massachusetts General Hospital DECLARATION
More informationWhat s new in heart failure management? Yonsei Cardiovascular Center Yonsei University College of Medicine
What s new in heart failure management? Yonsei Cardiovascular Center Yonsei University College of Medicine Current Guideline of Treatment Asymptomatic Mild/Mod Severe Refractory Correct Cause: Arrhythmias
More informationHeart Failure A Disease for the Internist?
Heart Failure A Disease for the Internist? Dr Chris Davidson Sussex Cardiac Centre BRIGHTON UK Hot Topics in Heart Failure Drug treatments Valsartan / neprilysin inhib Investigations BNP and others Devices
More informationHeart Failure: Combination Treatment Strategies
Heart Failure: Combination Treatment Strategies M. McDonald MD, FRCP State of the Heart Symposium May 28, 2011 None Disclosures Case 69 F, prior MIs (LV ejection fraction 25%), HTN No demonstrable ischemia
More informationKnown Actions of Digoxin
Known Actions of Digoxin Hemodynamic effects in heart failure Increases cardiac output, no effect on blood pressure Decreases PCWP Increases LVEF (
More informationRate of Heart failure guideline adherence in a tertiary care center in India after accounting for the therapeutic contraindications.
Article ID: WMC004618 ISSN 2046-1690 Rate of Heart failure guideline adherence in a tertiary care center in India after accounting for the therapeutic contraindications. Peer review status: No Corresponding
More informationCongestive Heart Failure: Outpatient Management
The Chattanooga Heart Institute Cardiovascular Symposium Congestive Heart Failure: Outpatient Management E. Philip Lehman MD, MPP Disclosure No financial disclosures. Objectives Evidence-based therapy
More informationFrom PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group
From PARADIGM-HF to Clinical Practice Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group PARADIGM-HF: Inclusion Criteria Chronic HF NYHA FC II IV with LVEF
More informationHF and CRT: CRT-P versus CRT-D
HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA
More informationNatriuretic Peptide Guided Therapy for Heart Failure
Natriuretic Peptide Guided Therapy for Heart Failure Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research Duke Clinical Research Institute Disclosures Research Grants
More informationThe National Heart Failure Audit 2010/2011
The National Heart Failure Audit 2010/2011 Project Steering Group; TA McDonagh, JG Cleland, HJ Dargie, S Hardman,P Mitchell, A Cunningham 85% NHS Trusts submitting data (133/156) 36,504 admissions 70%
More informationHeart Failure Management Policy and Procedure Phase 1
1301 Punchbowl Street, Harkness Suite 225 Honolulu, Hawaii 96813 Phone (808) 691-7220 Fax: (808) 691-4099 www.queenscipn.org Policy and Procedure Phase 1 Policy Number: Effective Date: Revised: Approved
More informationTo download handouts for today s presentation, click the three paper icon at the top right of your screen.
To download handouts for today s presentation, click the three paper icon at the top right of your screen. Get With The Guidelines Heart Failure PMT Spring Update September 9, 2013 Clyde W. Yancy, MD,
More information2/3/2017. Objectives. Effective Heart Failure Management through Evidence Based Practice and Innovation
Effective Heart Failure Management through Evidence Based Practice and Innovation Jennifer Bauerly RN, CHFN, APRN-BC CentraCare Heart and Vascular Center Objectives Describe the scope and impact of heart
More information9/24/2010 S U ts n ) s tie a 4.7 illio (m 3.5 ilu rt F a Outpatient e H Inpatient * 50 s 60 s 70 s >80
Exciting Times: Advances in Heart Failure Dana McGlothlin, MD Associate Professor of Medicine Advanced Heart Failure and Transplant Program Medical Director, CCU Overview HF Statistics Therapies for chronic
More informationChecklist for Treating Heart Failure. Alan M. Kaneshige MD, FACC, FASE Oklahoma Heart Institute
Checklist for Treating Heart Failure Alan M. Kaneshige MD, FACC, FASE Oklahoma Heart Institute Novartis Disclosure Heart Failure (HF) a complex clinical syndrome that arises secondary to abnormalities
More informationHeart Failure Background, recognition, diagnosis and management
Heart Failure Background, recognition, diagnosis and management Speaker bureau: Novartis At the conclusion of this activity, participants will be able to: Recognize signs and symptoms of heart failure
More informationHeart Failure A Team Approach Background, recognition, diagnosis and management
Heart Failure A Team Approach Background, recognition, diagnosis and management Speaker bureau: Novartis At the conclusion of this activity, participants will be able to: Recognize signs and symptoms of
More informationTranscatheter Mitral Valve Repair and Replacement: Where is the Latest Randomized Evidence Taking US Mitral-Fr, COAPT
Transcatheter Mitral Valve Repair and Replacement: Where is the Latest Randomized Evidence Taking US Mitral-Fr, COAPT and Saibal Kar, MD, FACC, FSCAI Professor of Medicine Director of Interventional Cardiac
More informationSara O. Weiss, MD Director, Heart Failure Services Virginia Mason Medical Center September 8, 2012
Sara O. Weiss, MD Director, Heart Failure Services Virginia Mason Medical Center September 8, 2012 Disclosure: Dr. Weiss has no significant financial interest in any of the products or manufacturers mentioned.
More informationNCAP NATIONAL CARDIAC AUDIT PROGR AMME NATIONAL HEART FAILURE AUDIT 2016/17 SUMMARY REPORT
NCAP NATIONAL CARDIAC AUDIT PROGR AMME NATIONAL HEART FAILURE AUDIT 2016/17 SUMMARY REPORT CONTENTS PATIENTS ADMITTED WITH HEART FAILURE...4 Demographics... 4 Trends in Symptoms... 4 Causes and Comorbidities
More informationTake-home Messages from Recent Heart Failure Trials: Heart Rate as a Target
Take-home Messages from Recent Heart Failure Trials: Heart Rate as a Target JEFFREY S. BORER, M.D. Professor and Chairman, Department of Medicine and Chief, Division of Cardiovascular Medicine; Director,
More informationStopping the Revolving Door of ADHF
Stopping the Revolving Door of ADHF Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center
More informationGuideline-Directed Medical Therapy
Guideline-Directed Medical Therapy Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation OPTIMAL THERAPY (As defined in
More informationESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure
ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg
More informationOptimizing CHF Therapy: The Role of Digoxin, Diuretics, and Aldosterone Antagonists
Optimizing CHF Therapy: The Role of Digoxin, Diuretics, and Aldosterone Antagonists Old Drugs for an Old Problem Jay Geoghagan, MD, FACC BHHI Primary Care Symposium February 28, 2014 None. Financial disclosures
More informationA patient with decompensated HF
A patient with decompensated HF Professor Michel KOMAJDA University Pierre & Marie Curie Pitie Salpetriere Hospital Department of Cardiology Paris (France) Declaration Of Interest 2010 Speaker : Servier,
More informationDevice Therapy for Heart Failure
Device Therapy for Heart Failure Dr. Shelley Zieroth FRCPC Assistant Professor, Cardiology, University of Manitoba Director of Cardiac Transplant and Heart Failure Clinics St Boniface General Hospital,
More informationUpdates in Congestive Heart Failure
Updates in Congestive Heart Failure GREGORY YOST, DO JOHNSTOWN CARDIOVASCULAR ASSOCIATES 1/28/2018 Disclosures Edwards speaker on Sapien3 valves (TAVR) Stages A-D and NYHA Classes I-IV Stage A: High risk
More informationCombination of renin-angiotensinaldosterone. how to choose?
Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants
More informationConnecting the Dots: Cluster Randomized Trial. Behavioral Economics and a. Adrian F. Hernandez, MHS
Connecting the Dots: Behavioral Economics and a Cluster Randomized Trial Adrian F. Hernandez, MHS Disclosures Research grant to the Duke Clinical Research Institute from: Novartis (Independent Investigator
More informationThe Role of ICD Therapy in Cardiac Resynchronization
The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine
More informationH2H Early Follow-up Challenge: See You in 7. Webinar #1 Thursday, March 3, :00 pm 4:00 pm ET. Welcome
H2H Early Follow-up Challenge: See You in 7 Webinar #1 Thursday, March 3, 2011 3:00 pm 4:00 pm ET 1 Welcome Take Home Messages Renew your H2H commitment Participate in the first H2H Challenge Help build
More informationHFpEF, Mito or Realidad?
HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY
More informationThe ACC Heart Failure Guidelines
The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA
More informationWhat s at the Heart of the Matter?
What s at the Heart of the Matter? Inpatient Pharmacy Services for Heart Failure Patients Jason Williamson, PharmD, BCPS Clinical Pharmacy Manager, PGY1 Pharmacy Residency Director Genesys Regional Medical
More informationChronic. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Michael G. Shlipak, MD, MPH
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationGWG Heart Failure Progress to Date. Lorraine Montoya BSN, MAdEd
GWG Heart Failure Progress to Date Lorraine Montoya BSN, MAdEd Our Partners Friday, May 6, 2011 The Heart Failure GAP Project Background HF is steadily increasing as a result of success in treating heart
More informationSliwa et al. JACC 2004;44:
TREATMENT OF ADVANCED HEART FAILURE HEART DISEASE IN KENTUCKY Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac
More informationEvaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF<40%
Evaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF
More informationDevices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine
Devices and Other Non- Pharmacologic Therapy in CHF Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Disclosure None University of Miami vs. OSU Renegade Miami football
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationSacubitril/valsartan: A New Management Strategy for the Treatment of Heart Failure. Elizabeth Pogge, PharmD, MPH, BCPS, FASCP
Sacubitril/valsartan: A New Management Strategy for the Treatment of Heart Failure Elizabeth Pogge, PharmD, MPH, BCPS, FASCP Disclosure Elizabeth Pogge reports no actual or potential conflicts of interest
More information