Raising expectations for Acute Heart Failure: What does the future bring to us?
|
|
- Trevor Cobb
- 5 years ago
- Views:
Transcription
1 Raising expectations for Acute Heart Failure: What does the future bring to us? Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland
2 Speaker disclaimer Receiving honoraria for lectures and membership of the advisory boards from Novartis, Johnson & Johnson, Bayer, Cardiorentis, Amgen, Servier, Coridea, Vifor 2
3 Outline Management of Acute Heart Failure Syndromes 1. Hurdles and disappointments in the everyday clinical practice 2. Outlook for the (nearest) future a. new approach: profiling and strategizing care b. can early, short-term intervention affect long-term outcomes? c. optimize peri-discharge management to improve the outcomes
4 Episode of HF worsening (regardless of being admitted to hospital or treated ambulatory) carries very high risk MADIT-CRT population: NYHA class I-II, optimally managed Annual mortality rate: Free of a primary HF event: 1.5 / 100 pt-yrs Outpatient HF event: 15.9 / 100 pt-yrs Inpatient HF event: 18.5 / 100 pt-yrs Skali H et al. Eur J Heart Fail 2014;16:560-5
5 Acute Heart Failure: landscape at the beginning of the 21 st century EURObservational Research Program: The Heart Failure Pilot Survey All-cause death or HF hospitalization 1892 pts with acute HF& 3226 pts with chronic HF 1-year all cause mortality: acute HF 16.8% chronic HF 6.8% Acute HF: 35.1% Cardiologist s summary: broadly speaking, the pharmacological armamentarium for AHFS loop diuretics, vasodilators and inotropes is largely unchanged from 1970s Felker GM et al., Circ Heart Fail 2010;3: Chronic HF: 17.2% It s hard to make predictions, particularly about the future. Days from enrolment Niels Bohr or Yogi Berra or Albert Einstein or Mark Twain A. Maggioni ESC 2011
6 Management of acute heart failure: why so difficult? Clinical Factors: Underlying causes: multifactorial, precipitating factor often not identified Clinical presentation: spectrum of various conditions, heterogeneous pathophysiology, different risk of subsequent complications Natural course complicated by worsening clinical status Cardiovascular and non-cardiovascular comorbidities Pathophysiological targets: uncertain End-points selection: not standardized
7 Initial, short-term therapies (hours-days) Target Traditional therapeutic approach Effects on long-term outcome Alleviate congestion i.v. diuretics? May be detrimental Reduce LV filling pressure Hypoperfusion Poor cardiac performance i.v. nitrates? i.v. inotropes Detrimental Dissociation between symptomatic improvement, clinical stabilisation & favourable long-term outcome Modified from Pang PS et al. Eur Heart J 2010;31:784-93
8 RECENT AHFS TRIALS Study Patients Primary End Point Natriuretic Peptide (Nesiritide) VMAC 489 PCWP 3 h and Dyspnoea 3 h PRECEDENT ASCEND HF Vasopressin Antagonists (Tolvaptan) Arrhythmias Change in dyspnoea at 6 and 24h HF hospitalization and death at 30 days ACTIV HF 319 Body wt 24 h and Worse HF 60 d EVEREST 3433 SERCA agonist & Na/K ATPase inhibitor (Istaroxime) Short term: Body wt + GCA at 7 days Long term: Mortality and Re-hospitalization HORIZON-HF 120 PCWP Changes from baseline Selective adenosine A 1 -receptor antagonist (Rolofylline) PROTECT 2033 Changes in dyspnoea Death or readmission through day 7 Courtesy of M. Metra
9 Outline Management of Acute Heart Failure Syndromes 1. Hurdles and disappointments in the everyday clinical practice 2. Outlook for the (nearest) future a. new approach: profiling and strategizing care b. can early, short-term intervention affect long-term outcomes? c. optimize peri-discharge management to improve the outcomes
10 Profiling and strategizing care in AHF Appropriate timing of each intervention Phases of AHF management Initial (ED/ICU/CCU) In-hospital Discharge Clinical tasks: Defining goals of treatment Characterizing patient clinical profile Strategizing care Monitoring effects of treatment
11 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 Initial phase in ED/ICU/CCU Profiling and strategizing care Clinical profile is fundamental for decision-making in AHF Strategy: identify and treat life-threatening conditions
12 Profiling AHF patients at the early stage: different therapies for different clinical profiles Hemodynamic profiles: Therapeutic consequences Warm & Dry Warm & Wet A dry-out B Cold & Dry L Cold & Wet C warm-up & dry-out Filippatos G et al, Heart Fail Rev 2007 ;12:87-90 Adapted from Stevenson LW, Eur J Heart Failure 2005;7:323
13 Profiling AHF patients at the peri-discharge phase: consequences for the management Clinical profile may affect management strategy in-hospital HF worsening HF aetiology cardiovascular and non-cardiovascular co-morbidities Immediate (ED/ICU/CCU) candidate for device therapy identification of high-risk patients Intermediate (in-hospital) Phases in the AHF management Pre-discharge management and long-term planning Modified from ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012
14 Improvement of heart failure Variability in the clinical course of AHF: steady improvement vs. worsening Effects of new therapy: prevention of WHF ~10 30% of patients develop WHF Intensification of treatment rescue therapy death WHF = worsening heart failure Time (days)
15 RELAX-AHF: Worsening of Heart Failure RELAX-AHF Cumulative proportion of worsening heart failure to Day 5 (%) *p<0.001 through Day 5 Kaplan-Meier estimate for time to WHF (%) **HR 0.7 (0.51, 0.96); p=0.024 n= Worsening Heart Failure (WHF) - worsening signs and/or symptoms of HF that required an intensification of IV therapy for heart failure or mechanical ventilatory or circulatory support. *p value by Wilcoxon test **p value by log rank test for Serelaxin vs. Placebo; HR estimate by Cox model, HR<1.0 favors Serelaxin Teerlink J. LBCT Presentation, AHA 2012
16 Why do we need to focus on in-hospital Worsening of Heart Failure? Represents meaningful change in clinical status leading to intensification / change of therapy Is associated with markers of end-organ damage and short- and long-term prognosis In-hospital worsening heart failure End-organ damage Outcomes (short & long-term) Adapted from M. Packer
17 Outline Management of Acute Heart Failure Syndromes 1. Hurdles and disappointments in the everyday clinical practice 2. Outlook for the (nearest) future a. new approach: profiling and strategizing care b. can early, short-term intervention affect long-term outcomes? c. optimize peri-discharge management to improve the outcomes
18 Need for paradigm shifting in acute heart failure: short-term intervention improving long-term outcomes Targeted-approach = characterizing patient clinical profile different pathophysiologies & therapies for different clinical profiles (?) An ideal drug / intervention What is needed? symptomatic improvement, end-organ protection, improvement in neurohumoral and proinflammtory profile Appropriate timing = early administration of therapy the earlier the better (?) prevention of tissue damage; phase of severe symptoms; early clinical stabilization & chance to introduce disease-modifying therapies
19 Fast and slow mechanisms of circulatory congestion Precipitant (minor) Sympathetic activation Renal and dietary mechanisms Mobilization of venous reservoir Sodium and water retention Fast Effective circulatory volume Slow Congestion Fallick et al. Circ Heart Failure 2011;4:669 75
20 Linking short-term intervention with long-term benefit: An ideal drug / intervention Targeting different pathophysiological mechanisms MORTALITY
21 Survival probability Need for paradigm shifting in acute heart failure: short-term intervention with favourable long-term effects Risk for All-Cause Mortality in Pre-RELAX-AHF, RELAX-AHF, and Combined Pre-RELAX-AHF: placebo Pre-RELAX-AHF: serelaxin RELAX-AHF: placebo RELAX-AHF: serelaxin Combined: placebo Combined: serelaxin Study Pre-RELAX-AHF: p=0.16 RELAX-AHF: p=0.020 Combined: p= Metra et al. JACC 2013;61:
22 Adverse Effects Benefits Effects of serelaxin versus current therapies Benefits Diuretics Nitrates Inotropes Serelaxin Dyspnea? Congestion? Worsening HF?? Length of Stay? Mortality? Troponin Hypotension Low High (Low) Low Tachycardia No Yes Yes No Myocardial Ischemia/ Necrosis No No Yes No Renal Dysfunction Yes No No No Neutral effect Positive effect Negative effect
23 New AHF (phase 3) Trials With Mortality EPs -2 N >6,000 BP 125 mmhg Treatment start within 16 hrs from hosp presentation Primary EP: CV death during 180 days N >2,150 4,000 BP >115 mmhg Treatment start within 12 hrs from hosp presentation Primary EP: CV deaths until end of trial and Clinical Composite at 48 h
24 Summary of the pharmacological effects of ularitide Hemodynamic (vasodilation) veins arteries Carstens. Clin Sci 1997;92: Bestle. Am J Physiol 1999;276:R Pro Arg Ser Ala Leu Arg Gly Arg Flüge. Regul Pept Thr Arg Gly Met Bronchodilation Ser Phe Asp NH 1995;59: Ser Cys Arg Arg Tyr Ser Phe S IIe Cys Gly Asn Gly Ala Leu Gly Ser Gin Neurohumoral RAAldosterone Endothelin Carstens. Clin Sci 1997;92: Bestle. Am J Physiol 1999;276: R Renal diuresis natriuresis Carstens. Clin Sci 1997;92: Bestle. Am J Physiol 1999;276:R684 95
25 Outline Management of Acute Heart Failure Syndromes 1. Hurdles and disappointments in the everyday clinical practice 2. Outlook for the (nearest) future a. new approach: profiling and strategizing care b. can early, short-term intervention affect long-term outcomes? c. optimize peri-discharge management to improve the outcomes
26 Goals of Treatment in Acute Heart Failure Treat symptoms Restore oxygenation Improve organ perfusion & haemodynamics Limit cardiac/renal damage Prevent thrombo-embolism Minimize ICU length of stay Immediate (ED/ICU/CCU) Maintain patient stabilisation with optimised treatment Initiate, up-titrate, optimize disease-modifying pharmacological therapy Identify aetiology and relevant co-morbidities Consider device therapy in appropriate patients Identify high-risk patients and evaluate fluid status Enrol in disease management programme, educate, initiate appropriate lifestyle adjustments Intermediate (in-hospital) Phases in the AHF management Pre-discharge management and long-term planning Modified from ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012
27 All-Cause Mortality by Beta-Blocker Use at Baseline and Discharge 1.0 Probability of survival Yes / Yes No / Yes No / No Yes / No Baseline Discharge Days since start of study drug infusion M. Boehm et al. Crit Care Medicine 2011
28 Number Courtesy J. McMurray PARADIGM-HF: cause/mode of death All causes CV causes Sudden Worsening HF Enalapril LCZ696 HR p = 0.84 <
29 PARADIGM-HF: Hospitalization for heart failure (%) Enalapril Proportion of patients HR 0.79 (0.71, 0.89) p < LCZ696 Number of admissions* RR 0.77 (0.67, 0.89) p = Courtesy J. McMurray Patients hospitalized Hospitalizations *Includes repeat episodes
30 Iron deficiency is common and predicts poor outcome in patients hospitalized for AHF Cumulative survival 100% 93% (81-100%) 85% (75-95%) χ 2 =29.45, p< % (47-71%) Iron deficiency (both low hepcidin and high stfr) (1) Isolated high stfr (2) Isolated low hepcidin (3) Preserved iron status (4) Follow-up (months) Jankowska EA et al. Eur Heart J 2014 (in press)
31 Influence of time from discharge and length of hospital stay on risk of death after discharge from a hospitalization for HF most vulnerable period Solomon S D et al. Circulation. 2007;116:
32 broadly speaking, the pharmacological armamentarium for AHFS loop diuretics, vasodilators and inotropes is largely unchanged from 1970s Felker GM et al., Circ Heart Fail 2010;3: Sunrise or sunset? The results of the new trials will entirely change this perspective (?)
2016 ESC Heart Failure Guidelines: what is new? Piotr Ponikowski Wroclaw, Poland
2016 ESC Heart Failure Guidelines: what is new? Piotr Ponikowski Wroclaw, Poland Disclosures Consultancy fees and speaker s honoraria from: Amgen, Servier, Novartis, Johnson & Johnson, Merck, Berlin Chemie,
More informationSlide 1. Slide 2. Slide 3. Managing Acute Heart Failure Trials and Tribulations. Declaration of
Slide 1 Managing Acute Heart Failure Trials and Tribulations Martin R Cowie MD MSc FRCP FRCP (Ed) FESC Professor of Cardiology, Imperial College London m.cowie@imperial.ac.uk @ProfMartinCowie Slide 2 Declaration
More informationNovel Natriuretic Peptides
Novel Natriuretic Peptides Frank Ruschitzka, MD, FRCP, FESC Professor of Cardiology Director, Heart Failure and Transplantation Clinic University Hospital Zürich, Switzerland Conflict of interest: Aventis,
More informationAcute Heart Failure: Update Gerasimos Filippatos, MD, FESC, FHFA President HFA
Acute Heart Failure: Update 2015 Gerasimos Filippatos, MD, FESC, FHFA President HFA Disclosures Principal Investigator or Committee member in trials sponsored by Novartis, Bayer, Cardiorentis, Vifor, European
More informationTreating the patient with acute heart failure. What do we really know? Principles of acute heart failure treatment
ESC 2012 27Aug - 3Sep, 2012, Munich, Germany Treating the patient with acute heart failure. What do we really know? Principles of acute heart failure treatment Marco Metra, MD, FESC Cardiology University
More informationAldosterone Antagonist. Hyd/ISDN*
Μedical management of heart failure: Update 2014 Dr John T Parissis Attikon University Hospital Athens, Greece Disclosures: Received honoraria as consultant or research grants by Orion- Pharma, Servier,
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 informationState of the Art: acute heart failure Is it just congestion?
ESC CONGRESS 2017 Barcelona, 26. 30. August 2017 State of the Art: acute heart failure Is it just congestion? S.B. Felix, FESC Klinik für Innere Medizin B Ernst-Moritz-Arndt-Universität Greifswald 1456
More informationACUTE HEART FAILURE. Julie Gorchynski MD, MSc, FACEP, FAAEM. Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014
ACUTE HEART FAILURE Julie Gorchynski MD, MSc, FACEP, FAAEM Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014 No disclosures Objectives Overview Cases Current Therapy
More informationAcute heart failure syndromes: clinical challenges. Pathophysiology. ESC Congress August. Paris, France. Marco Metra
ESC Congress 2011 27-31 August. Paris, France. Acute heart failure syndromes: clinical challenges. Pathophysiology Marco Metra Cardiology, Dept. Of experimental and applied medicine. University of Brescia.
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationIntravenous Inotropic Support an Overview
Intravenous Inotropic Support an Overview Shaul Atar, MD Western Galilee Medical Center, Nahariya Affiliated with the Faculty of Medicine of the Galilee, Safed, Israel INOTROPES in Acute HF (not vasopressors)
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 informationManagement of acute decompensated heart failure and cardiogenic shock. Arintaya Phrommintikul Department of Medicine CMU
Management of acute decompensated heart failure and cardiogenic shock Arintaya Phrommintikul Department of Medicine CMU Acute heart failure: spectrum Case 64 y/o M with Hx of non-ischemic DCM (LVEF=25-30%)
More informationCardio-Renal Syndrome in Acute Heart Failure:
Cardio-Renal Syndrome in Acute Heart Failure: Target for Therapy Marvin A. Konstam, M.D. Research support and/or consulting relevant to this lecture: Merck, Otsuka, Johnson & Johnson; Amgen; Cardiokine
More informationHow to define the target population?
Heart Failure 2011 22-24 May. Gothenburg, Sweden Mortality or morbidity as target in acute heart failure trials How to define the target population? Marco Metra, Brescia The Burden of Acute HF Acute HF
More informationBehandeling van Hartfalen: over 5 jaar
Behandeling van Hartfalen: over 5 jaar Adriaan Voors, cardioloog UMCG Over 5 jaar Heart Failure Treatment in 5 Years HFrEF: best evidence, biggest pipeline Entresto Omcamtiv LVAD: destination therapy HFrEF:
More informationHeart failure: what should be changed? Prof. Gerasimos Filippatos Attikon University Hospital
Heart failure: what should be changed? Prof. Gerasimos Filippatos Attikon University Hospital Disclosures Chair or Committee Member of trials or registries sponsored by Novartis, Bayer, Cardiorentis, Servier
More informationPivotal Role of Renal Function in Acute Heart failure
Pivotal Role of Renal Function in Acute Heart failure Doron Aronson MD, FESC Department of Cardiology RAMBAM Health Care Campus Haifa, Israel Classification and definitions of cardiorenal syndromes CRS
More informationTips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance
Tips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance J. Parissis Attikon University Hospital, Athens, Greece Disclosures ALARM investigator received
More informationOvercoming the Cardiorenal Syndrome
Overcoming the Cardiorenal Syndrome October 29, 2016 Randall C Starling MD MPH FACC FESC FHFSA FHFA Professor of Medicine Heart & Vascular Institute Cleveland Clinic Lerner College of Medicine Cleveland
More informationManagement of chronic heart failure: update J. Parissis Attikon University Hospital
Management of chronic heart failure: update 2015 J. Parissis Attikon University Hospital Disclosures: received honoraria for lectures from Servier, Pfizer, Novartis Discharges in Thousands Heart Failure
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 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 informationTherapy for acute heart failure time for change?!
Therapy for acute heart failure time for change?! Chaired by Professor Stefan Anker Charité Medical School, Berlin, Germany President of the ESC Heart Failure Association (HFA) 14 th February 2013 A satellite
More informationAccepted Manuscript. Tolvaptan in Acute Heart Failure: Time to Move On. Randall C. Starling, MD MPH, James B. Young, MD
Accepted Manuscript Tolvaptan in Acute Heart Failure: Time to Move On Randall C. Starling, MD MPH, James B. Young, MD PII: S0735-1097(16)35324-4 DOI: 10.1016/j.jacc.2016.09.005 Reference: JAC 22962 To
More informationSerelaxin: insights into its haemodynamic, biochemical, and clinical effects in acute heart failure
Serelaxin: insights into its haemodynamic, biochemical, and clinical effects in acute heart failure Item Type info:eu-repo/semantics/article Authors Hernández, Adrian V. Citation Eur Heart J (2014) 35
More informationHeart Failure and Renal Failure. Gerasimos Filippatos, MD, FESC, FHFA President HFA
Heart Failure and Renal Failure Gerasimos Filippatos, MD, FESC, FHFA President HFA Definition Epidemiology Pathophysiology Management (?) Recommendations for NHLBI in cardiorenal interactions related to
More informationTERAPIA DELLO SCOMPENSO DAI BETA- BLOCCANTI AGLI ARNI (ARNI SI ARNI NO) Iseo 10 Novembre 2018
TERAPIA DELLO SCOMPENSO DAI BETA- BLOCCANTI AGLI ARNI (ARNI SI ARNI NO) Iseo 10 Novembre 2018 Carlo Lombardi Cattedra di Cardiologia Università e Spedali Civili di Brescia All-cause mortality in the European
More informationThe Hearth Rate modulators. How to optimise treatment
The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,
More informationDIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE
DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE Mefri Yanni, MD Bagian Kardiologi dan Kedokteran Vaskular RS.DR.M.Djamil Padang The 3rd Symcard Padang, Mei 2013 Outline Diagnosis Diagnosis Treatment options
More informationAcute heart Failure. Critical cardiac care: update Markku S. Nieminen Helsinki, Finland. M S Nieminen, AHF ,ESC Stockholm
Acute heart Failure Critical cardiac care: update 2010 Markku S. Nieminen Helsinki, Finland M S Nieminen, AHF 300810,ESC Stockholm Acute heart Failure Critical cardiac care: update 2010 Markku S. Nieminen
More informationWhat serelaxin promises: the RELAX-AHF data
What serelaxin promises: the RELAX-AHF data Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland Ideal properties for AHF therapy Pang
More informationAdvanced Care for Decompensated Heart Failure
Advanced Care for Decompensated Heart Failure Sara Kalantari MD Assistant Professor of Medicine, University of Chicago Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation
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 informationMANAGEMENT OF ACUTE PULMONARY EDEMA. Pr. NOUIRA Semir Emergency Department Fattouma Bourguiba University Hospital
MANAGEMENT OF ACUTE PULMONARY EDEMA Pr. NOUIRA Semir Emergency Department Fattouma Bourguiba University Hospital ACUTE HEART FAILURE 35% 10% Goals of Acute Management Rapidly improve symptoms while preserving
More informationChristopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine (adj.) Duke University Editor
New Strategies in the Management of Acute and Advanced Heart Failure Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine (adj.) Duke University
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 informationMedical Management of Acute Heart Failure
Critical Care Medicine and Trauma Medical Management of Acute Heart Failure Mary O. Gray, MD, FAHA Associate Professor of Medicine University of California, San Francisco Staff Cardiologist and Training
More informationUpdate on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy
Update on pharmacological treatment of heart failure Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Presenter Disclosures Dr. Maggioni : Serving in Committees of studies sponsored
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 information«New drugs» Postgraduate Course Heart Failure Session
«New drugs» Postgraduate Course Heart Failure Session Dr A. Testuz Service de cardiologie Hôpitaux Universitaires de Genève Joint annual meeting SSC/SSCS-SSP 15.06.2016 Lausanne HFrEF Positive drug, device
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 informationMortality as an Efficacy or Safety Endpoint : Lessons Learned from the Heart Failure Trials
Mortality as an Efficacy or Safety Endpoint : Lessons Learned from the Heart Failure Trials Christopher M. O Connor, MD Professor of Medicine Director, Duke Heart Center Acting Chief, Division of Cardiology
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 informationMedical Management of Acutely Decompensated Heart Failure. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Medical Management of Acutely Decompensated Heart Failure William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Goals of Acute Heart Failure Therapy Alleviate
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 informationThe right heart: the Cinderella of heart failure
The right heart: the Cinderella of heart failure Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland none Disclosure Look into the Heart
More informationGerasimos Filippatos MD, FESC, FCCP, FACC
Gerasimos Filippatos MD, FESC, FCCP, FACC Head of HF Unit at Athens University Hospital, Greece President (2014-2016) of the HF Association of the European Society of Cardiology (ESC) Served as Chair of
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 informationHeart Failure Medical and Surgical Treatment
Heart Failure Medical and Surgical Treatment Daniel S. Yip, M.D. Medical Director, Heart Failure and Transplantation Mayo Clinic Second Annual Lakeland Regional Health Cardiovascular Symposium February
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 informationMonitoring of Renal Function in Heart Failure
Monitoring of Renal Function in Heart Failure Adriaan A. Voors, cardiologist The Netherlands Disclosures AAV received consultancy fees and/or research grants from: Alere, Bayer, Cardio3Biosciences, Celladon,
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 informationHFpEF 2016 : Comorbidities and Outcomes
HFpEF 2016 : Comorbidities and Outcomes Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine, Duke University Editor in Chief, JACC: Heart
More informationThe LBCT of 2017 Heart Failure Trials. Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA
The LBCT of 2017 Heart Failure Trials Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA TRUE-AHF RELAX-AHF-2 Beta blockers in patients with HF with and without atrial fibrillation TRUE-AHF Additional Analysis
More informationBehandlungsalgorithmus bei Herzinsuffizienz mit reduzierter Auswurffraktion
Behandlungsalgorithmus bei Herzinsuffizienz mit reduzierter Auswurffraktion Professor Dr. med. Roger Hullin Leiter Programm für Schwere Herzinsuffizienz, VAD & Herztransplantation Suisse Romande Klinik
More informationPravin Manga Division of Cardiology Department of Medicine University of Witwatersrand
Pravin Manga Division of Cardiology Department of Medicine University of Witwatersrand Overview Definition Epidemiology Biomarkers Treatment Clinical Heart Failure: Syndrome in which patients have typical
More informationIntegrating Current Knowledge into Consensus Guidelines for Acute Decompensated Heart Failure
Integrating Current Knowledge into Consensus Guidelines for Acute Decompensated Heart Failure J. Herbert Patterson, Pharm.D., FCCP One of Four Continuing Education Programs in the Series, Acute Decompensated
More informationPractical Points in Cardiorenal Syndrome
Practical Points in Cardiorenal Syndrome Vichai Senthong, MD. Cardiovascular Unit, Faculty of Medicine Khon Kaen university HFCT Annual Scientific Meeting June 16, 2017, Eastin Grand Sathorn Hotel, Bangkok
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 informationΟξεία καρδιακή ανεπάρκεια: Ποιες παράμετροι συμβάλλουν στη διαστρωμάτωση κινδύνου των ασθενών;
Οξεία καρδιακή ανεπάρκεια: Ποιες παράμετροι συμβάλλουν στη διαστρωμάτωση κινδύνου των ασθενών; Γ. Φιλιππάτος, MD, FACC, FESC, FCCP Επ. Καθηγητής Καρδιολογίας Πανεπ. Αθηνών Clinical Outcomes in Patients
More informationHeart Failure : Current Management and beyond. Gerasimos Filippatos, MD, FESC, FCCP President Elect Heart Failure Association ESC
Heart Failure : Current Management and beyond Gerasimos Filippatos, MD, FESC, FCCP President Elect Heart Failure Association ESC Acute Heart Failure Chronic Heart Failure Devices Acute Heart Failure Chronic
More informationSacubitril/Valsartan unter der Lupe Subgruppenanalysen, real world data,
Sacubitril/Valsartan unter der Lupe Subgruppenanalysen, real world data, praktische Erfahrungen michael.boehm@uks.eu M. Böhm Innere Medizin III (Kardiologie / Angiologie / Internistische Intensivmedizin)
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Proposed Health Technology Appraisal. Serelaxin for treating acute decompensation of heart failure
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Proposed Health Technology Appraisal Serelaxin for treating acute decompensation of heart Draft scope (pre-referral) Draft remit/appraisal objective To
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 informationEffect of Ularitide on Cardiovascular Mortality in Acute Heart Failure (TRUE-AHF)
Effect of Ularitide on Cardiovascular Mortality in Acute Heart Failure (TRUE-AHF) Elizabeth Tien, PharmD, BCPS PGY2 Cardiology Pharmacy Resident Moses H. Cone Memorial Hospital Greensboro, NC Kristen Pogue,
More informationInotropes for the treatment of advanced heart failure: The role of intermittent administration
Inotropes for the treatment of advanced heart failure: The role of intermittent administration Dr John T Parissis, Heart Failure Unit, Attikon University Hospital Athens, Greece Disclosures - ALARM investigator
More informationThe Cardiorenal Syndrome in Heart Failure
The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October 9, 2015 Disclosures None 1 Cardiorenal Syndrome (CRS) A pathophysiologic
More informationHeart Failure (HF) Treatment
Heart Failure (HF) Treatment Heart Failure (HF) Complex, progressive disorder. The heart is unable to pump sufficient blood to meet the needs of the body. Its cardinal symptoms are dyspnea, fatigue, and
More informationImpact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction
Impact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction Masahito Shigekiyo, Kenji Harada, Ayumi Okada, Naho Terada, Hiroyoshi Yoshikawa, Akira Hirono,
More informationThe Art and Science of Diuretic therapy
The Art and Science of Diuretic therapy Dr. Fayez EL Shaer Associate Professour of cardiology Consultant cardiologist MD, MSc, PhD, CBNC, NBE FESC, ACCP, FASNC,HFA KKUH, KFCC Heart failure: fluid overload
More informationCase Presentation. This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
Worsening Renal Function in Heart Failure Patients Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center
More informationAcute heart failure, beyond conventional treatment: persisting low output
Acute heart failure, beyond conventional treatment: persisting low output Alexandre Mebazaa, FESC Hôpital Lariboisière, Université Paris 7 U942 Inserm Conflict of Interest Lecture fee: Orion No other conflicts
More informationNatriuretic Peptides The Cardiologists View. Christopher defilippi, MD University of Maryland Baltimore, MD, USA
Natriuretic Peptides The Cardiologists View Christopher defilippi, MD University of Maryland Baltimore, MD, USA Disclosures Research support: Alere, BG Medicine, Critical Diagnostics, Roche Diagnostics,
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 informationLCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor
The Angiotensin Receptor Neprilysin Inhibitor LCZ696 in Heart Failure with Preserved Ejection Fraction The Prospective comparison of ARNI with ARB on Management Of heart failure with preserved ejection
More informationROSE-AHF and Beyond. Gerasimos Filippatos, FESC, FHFA President Heart Failure Association
ROSE-AHF and Beyond Gerasimos Filippatos, FESC, FHFA President Heart Failure Association From: Braunwald s Heart Disease. 9th ed. Philadelphia, Elsevier, 2011 Determinants and forms of worsening renal
More informationUPDATES IN MANAGEMENT OF HF
UPDATES IN MANAGEMENT OF HF Jennifer R Brown MD, MS Heart Failure Specialist Medstar Cardiology Associates DC ACP Meeting Fall 2017 Disclosures: speaker bureau for novartis speaker bureau for actelion
More informationHFA- ESC criteria for Advanced HF and US Requirements for Destination Therapy
HFA- ESC criteria for Advanced HF and US Requirements for Destination Therapy ESC- HFA criteria for Adv-HF Severe symptoms of HF (NYHA class III or IV) with episodes of fluid retention and/or peripheral
More informationSystolic Dysfunction Clinical/Hemodynamic Guide for Management; New Medical and Interventional Therapeutic Challenges
Systolic Dysfunction Clinical/Hemodynamic Guide for Management; New Medical and Interventional Therapeutic Challenges Clyde W. Yancy, MD, MSc, FACC, FAHA, MACP Magerstadt Professor of Medicine Professor,
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 informationAnaemia in Chronic Heart Failure
Anaemia in Chronic Heart Failure 2011 Update Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland DECLARATION OF CONFLICT OF INTEREST
More informationDisclosures for Presenter
A Comparison of Angiotensin Receptor- Neprilysin Inhibition (ARNI) With ACE Inhibition in the Long-Term Treatment of Chronic Heart Failure With a Reduced Ejection Fraction Milton Packer, John J.V. McMurray,
More informationINIBITORI NEPRILISINA
INIBITORI NEPRILISINA Marco Canepa, MD, PhD Università degli Studi di Genova Cardiologia, Ospedale Policlinico San Martino IRCCS marco.canepa@unige.it ARNI: ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITORS
More informationCardiorenal Syndrome
SOCIEDAD ARGENTINA DE CARDIOLOGIA Cardiorenal Syndrome Joint session ESC-SAC ESC Congress 2012, Munich César A. Belziti Hospital Italiano de Buenos Aires I have no conflicts of interest to declare Cardiorenal
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 informationDisclosure of Relationships
Disclosure of Relationships Over the past 12 months Dr Ruilope has served as Consultant and Speakers Bureau member of Astra-Zeneca, Bayer, Daiichi-Sankyo, Menarini, Novartis, Otsuka, Pfizer, Relypsa, Servier
More informationSacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC
Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Head of Cardiology Medical Manager / CV Program CHUM Disclosure Statement Within the past two years: I have had an
More informationHeart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)
Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types
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 with Reduced EF. Dino Recchia, MD, FACC, FHFSA
Heart Failure with Reduced EF Dino Recchia, MD, FACC, FHFSA Heart Failure HF is the end phenotype of almost all CV disorders Complex clinical syndrome resulting from any structural or functional impairment
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 informationAcute HF is a complex and often life-threatening clinical condition. 1 Existing
ACUTE HEART FAILURE: WHAT IS NEW? John Parissis, MD, PhD; Vasiliki Bistola, MD Author affiliations: Heart Failure Unit, University of Athens, Athens, Greece Address for correspondence: John Parissis, Navarinou
More informationSatish K Surabhi, MD.FACC,FSCAI,RPVI Medical Director, Cardiac Cath Labs AnMed Health Heart & Vascular Care
Satish K Surabhi, MD.FACC,FSCAI,RPVI Medical Director, Cardiac Cath Labs AnMed Health Heart & Vascular Care None Fig. 1. Progression of Heart Failure.With each hospitalization for acute heart failure,
More informationHeart Failure and Renal Disease Cardiorenal Syndrome
Advanced Heart Failure: Clinical Challenges Heart Failure and Renal Disease Cardiorenal Syndrome 17 th Apr 2015 Ju-Hee Lee, M.D Cardiovascular Center, Chungbuk National University Hospital Chungbuk National
More informationAkash Ghai MD, FACC February 27, No Disclosures
Akash Ghai MD, FACC February 27, 2015 No Disclosures Epidemiology Lifetime risk is > 20% for American s older than 40 years old. > 650,000 new cases diagnosed each year. Incidence increases with age: 2%
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 informationNew NICE Heart Failure Guidelines What do they mean for primary and secondary care, and patients?
New NICE Heart Failure Guidelines 2018 - What do they mean for primary and secondary care, and patients? Prof Ahmet Fuat PhD FRCGP FRCP PG Dip (Cardiology) GP & GPSI Cardiology Darlington Professor of
More informationPathophysiologic targets for acute heart failure therapy: The Cardiorenal Syndrome
Pathophysiologic targets for acute heart failure therapy: The Cardiorenal Syndrome Frank Ruschitzka, MD, FRCP, FESC Professor and Co-Head, Dept of Cardiology President-elect ESC-HFA University Heart Center
More information