Non-obstructive hypertrophic cardiomyopathy - treatment
|
|
- Denis Williamson
- 5 years ago
- Views:
Transcription
1 Suvremeni pristup u liječenju i praćenju bolesnika s kroničnim zatajivanjem srca Non-obstructive hypertrophic cardiomyopathy - treatment dr. sc. Jure Samardžić, dr. med. Medicinski fakultet Sveučilišta u Zagrebu Klinika za bolesti srca i krvnih žila Klinički bolnički centar Zagreb
2 Ciljevi i ishodi učenja Razumijeti važnost zatajivanja srca i prepoznati kliničke prezentacije zatajivanja srca (ZS) Znati algoritam dijagnostike te vrste i težine prezentacije ZS te prepoznati odgovarajući trenutak referiranja višem centru Poznavati suvremene opcije u liječenju bolesnika sa ZS Znati o skrbi za bolesnike s kroničnim ZS
3 Agenda Definicija i epidemiologija ZS Klinički sindromi Dijagnostika Liječenje Tips and tricks Zaključak
4 Zatajivanje srca (ZS) Nemogućnost pružanja odgovarajućeg minutnog volumena organizmu u mirovanju ili opterećenju, ili pružanje odgovarajućeg minutnog volumena isključivo u uvjetima povišenih tlakova punjenja srca. E. Braunwald, modificirali B. Borlaugh i M. Redfield Sindrom koji obuhvaća tipične simptome (zaduha, oticanje nogu i zamor) i znakove (naglašeno punjene jugularne vene, krepitacije na plućima i pomak iktusa srca) kao posljedicu poremećaja strukture ili funkcije srca. Mc Murray et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure European Heart Journal (2012):33;
5 Zatajivanje srca više hospitalizacija od IM i karcinoma Ekman Circ CV Outcomes 2010
6 Incidencija i prevalencija ZS Oko 25 milijuna bolesnika diljem svijeta 5-10/1000 novoboljelih/godišnje Prevalencija ovisna o dobi: okvirno 1 2% odraslog stanovništva razvijenih zemalja; 10% među populacijom starom 70 ili više godina Braunwald E. Heart failure. J Am Coll Cardiol HF 2013;1:1 20
7 Srčano zatajivanje je progresivna bolest s visokom stopom smrtnosti Kronično opadanje Funkcija i kvaliteta života(qol ) Smrtnost Akutne epizode Progresija bolesti Adapted from Gheorghiade et al. Am J Cardiol Gheorghiade et al. Am J Cardiol 2005;96:11G 17G; 2. Gheorghiade & Pang. J Am Coll Cardiol 2009;53:
8 Visoka stopa hospitalizacije i smrtnosti od ZS 4 7 % hospitalna smrtnost* 1 3 BOLNICA Vrijeme proteklo od hospitalizacije 30 dana Stopa smrtnosti 10.4 % 1 godina 22.0 % 5 godina 42.3 % Analysis of data from 1,282 incident cases of heart failure in the Atherosclerosis Risk in Communities (ARIC) population-based study of n=15,792 individuals from four communities in the USA ( ). Loehr et al. Am J Cardiol 2008;101:
9 5-godišnje preživljenje nakon prve hospitalizacije zbog ZS, IM ili karcinoma Stewart Eur J Heart Fail. 200
10 Iznenadna smrt Iznenadna srčana smrt odgovorna je za približno polovicu svih smrti u srčanom zatajivanju 1 3 Postotak varira ovisno o NYHA klasi i veći je u bolesnika s blagim i umjerenim simptomima (NYHA klase II III) 2,3 Težina bolesti i uzrok smrti u MERIT-HF ispitivanju 2 NYHA II NYHA III NYHA IV 64% 12% 24% 59% 26% 15% 33% 11% 56% KZS Ostalo Iznenadna smrt n=103 n=103 n=27 KZS=kronično zatajivanje srca HF=heart failure; MERIT- HF=Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure; NYHA=New York Heart Association 1. McMurray et al. Eur Heart J 2012;33: ; 2. MERIT-HF. Lancet 1999;353:2001 7; 3. Desai et al. Eur Heart J 2015;36:1990 7
11 Koronarna bolest kao vodeći uzrok zatajivanja srca Novo dijagnosticirani bolesnici <75 god. u Britanskoj populacijskoj studiji Fox et al. Eur H Journal 2001
12 Agenda Definicija i epidemiologija ZS Klinički sindromi Dijagnostika Liječenje Tips and tricks Zaključak
13 Simptomi i znakovi zatajivanja srca Simptomi Tipični Zaduha Ortopneja Paroksizmalna noćna dispneja Smanjeno podnošenje fizičkog opterećenja Zamor, produljeni oporavak nakon fizičkog opterećenja Otjecanje gležnjeva Manje tipični Noćni kašalj Znakovi Više specifični Nabreknute jugularne vene Hepatojugularni refluks Treći srčani ton (galopni ritam) Lateralni pomak iktusa srca Srčani šum Manje specifični Periferni edemi (gležnjevi, sakrum, skrotum) Zviždanje Povećanje tjelesne težine (>2 kg/tjedan) Gubitaktjelesne težine (uznapredovalo ZS) Osjećaj nadutosti Gubitak apetita Zbunjenost Depresija Palpitacije Sinkopa Zastojni hropci Tiše disanje i perkutorna muklina na pl. bazama (pl. izljev) Tahikardija Iregularan puls Tahipneja (>16 udisaja/min) Hepatomegalija Ascites Kaheksija
14 Zatajivanje s očuvanom vs. smanjenom sistoličkom funkcijom srca Obilježje Dijastoličko ZS Sistoličko ZS Dob Često stariji Sve dobi (50-70g) Spol Često žene Česće muškarci EF LK Očuvana/normalna, >45% Smanjena, obično <45% Veličina LK Normalna, često uz hipertrofiju Obično proširena Hipertrofija LK (EKG) Obično prisutna Ponekad prisutna RTG s/pl. Kongestija bez kardiomegalije Galopni ritam S4 S3 Hipertenzija Sećerna bolest Prethodni IM Pretilost KOPB ++ 0 Apneja u snu Dugotrajna dijaliza ++ 0 Kongestija i kardiomegalija Atrijska fibrilacija + (često paroksizmalna) + (često perzistentna)
15 New York Heart Association (NYHA) funkcijska klasifikacija - težina simptoma pri fizičkim aktivnostima Stupanj I Bez ograničenja fizičke aktivnosti. Uobičajena aktivnost ne uzrokuje pojačanu zaduhu, zamor ili palpitacije. Stupanj II Blago ograničenje fizičke aktivnosti. Bez tegoba u mirovanju, ali uobičajena fizička aktivnost uzrokuje pojačanu anu zaduhu, zamor ili palpitacije. Stupanj III Značajno ograničenje fizičke aktivnosti. Bez tegoba u mirovanju, ali manje nego uobičajena fizička aktivnost uzrokuje pojačanu zaduhu, zamor ili palpitacije. Stupanj IV Nemogućnost obavljanja fizičke aktivnosti bez nelagode. Moguća je pojava simptoma u mirovanju. Pojačana nelagoda u slučaju bilo kakve fizičke aktivnosti.
16 Agenda Definicija i epidemiologija ZS Klinički sindromi Dijagnostika Liječenje Tips and tricks Zaključak
17 Pacijent sa sumnjom na KSZ Procjena vjerojatnosti Anamneza : Koronarna bolest Hipertenzija Izloženost kardiotoksičnim lijekovima Ortopnea Fizikalni pregled : Krepitacije Periferni edemi Srčani šum Distenzija vratnih vena EKG : Abnormalnost bilo kojeg tipa >1 NTproBNP > 125 pg/ml ili BNP > 35 pg/ml Ehokardiografija
18 Dijagnoza zatajivanja srca Zatajivanje srca sa smanjenom sistoličkom funkcijom Tipični simptomi ZS Tipični znakovi ZS* Smanjena ejekcijska frakcija LK Zatajivanje srca s očuvanom sistoličkom funkcijom Tipični simptomi ZS Tipični znakovi ZS* Normalna ili tek blago smanjena ejekcijska frakcija LK i nedilatirana LK Značajna strukturna bolest srca (hipertrofija LK, uvećanje LA) i/ili dijastolička disfunkcija * tipični znakovi ne moraju biti prisutni u ranim stupnjevima ZS (osobito s očuvanom sistoličkom funkcijom) i u bolesnika liječenih diureticima
19 Prva prezentacija popuštanja srca Dolazi do naglog pogoršanja Bolesnik se najčešće prezentira u HS i završava na bolničkom liječenju Tada je potrebno učiniti obradu i ustanoviti uzrok CMP Potrebno je uvesti optimalnu medikamentnu terapiju
20 EKG i zatajivanje srca EuroHeart Failure Survey Khan et al., EJHF 2007
21 Laboratorijska obrada Hgb KKS Na, K, urea, kreatinin (egfr) AST, ALT, GGT, bilirubin Lipidogram TSH Fe, TIBC, UIBC, feritin
22 RTG srca i pluća
23 Ehokardiografija Uvid u morfologiju i funkciju: Srčanog mišića Srčanih zalistaka perikarda Mjere srčanih šupljina Procjena sistoličke / dijastoličke funkcije Neinvazivna procjena hemodinamike Uvid u etiologiju bolesti srca
24 Koronarografija Sumnja na ishemijsku etiologiju bolesti (umjerena ili visoka vjerojatnost koronarne bolesti; pozitivan nalaz testa opterećenja) Bolesnici s anamnezom simptomatskih ventrikulskih aritmija ili aresta Bolesnici s anginoznim tegobama unatoč medikamentnoj terapiji
25 MR srca Bolesnici s lošim eho-prozorom Kongenitalne srčane bolesti MR uz LGE ishemijsko vs. neishemijsko oštećenje miokarda Karakterizacija tkiva Miokarditis, Amiloidoza, Sarkoidoza, Mb. Fabry, LVNC, Hemokromatoza...
26 Genetsko testiranje
27 Agenda Definicija i epidemiologija ZS Klinički sindromi Dijagnostika Liječenje Tips and tricks Zaključak
28 Ciljevi liječenja PRODULJENJE ŽIVOTA Smanjenje incidencije nagle srčane smrti KVALITETA ŽIVOTA Poboljšanje funkcijskog kapaciteta TROŠKOVI ZDRAVSTVENE SKRBI Smanjenje broja hospitalizacija
29 Nefarmakološko liječenje Blaga do umjerena fizička aktivnost Dijeta siromašna solju i životinjskim mastima Izbjegavanje težih psihofizičkih napora Paziti na unos tekućine Ne konzumirati alkohol Ne pušiti
30 Opadanje sistoličke funkcije vodi do aktivacije triju glavnih neurohormonalnih sustava Sustav natriuretskih peptida 1 NPR-i NP-i Vazodilatacija Krvni tlak Simpatički tonus Natriureza/diureza Vazopresin Aldosteron Fibroza Hipertrofija SIMPTOMI & PROGRESIJA ZS-A Simpatički živčani sustav 2,3 Epinefrin Norepinefrin α 1, β 1, β 2 receptori Vazokonstrikcija RAAS aktivnost Vazopresin Srčana frekvencija Kontraktilnost Renin-angiotenzinaldosteronski sustav 3,4 Ang II AT 1 R Ang = angiotenzin; AT1R = angiotenzin II receptor tipa 1; ZS = zatajenje srca; NP-i = natriuretski peptidi; NPR-i = receptori za natriuretske peptide; RAAS = renin-angiotenzin-aldosteronski sustav, ZS= zatajivanje srca Levin et al. N Engl J Med 1998;339:321 8; Nathisuwan & Talbert. Pharmacotherapy 2002;22:27 42; Kemp & Conte. Cardiovascular Pathology 2012; ; Schrier & Abraham. N Engl J Med 2009;341: Vazokonstrikcija Krvni tlak Simpatički tonus Aldosteron Hipertrofija Fibroza
31 Ključna ispitivanja u zatajivanju srca sa smanjenom EF SOLVD-T 1 (1991) 2,569 bolesnika Enalapril (ACEi) vs placebo: 16% ukupna smrtnost CHARM-Alternative 3 (2003) 2,028 bolesnika Kandesartan (ARB) vs placebo: 23% KV smrtnost ili HF hospitalizacija SHIFT 5 (2010) 6,558 bolesnika Ivabradin (I f inhibitor) vs placebo: 18% KV smrtnost ili HF hospitalizacija PARADIGM-HF 7 (2014) 8,442 bolesnika Sakubitril/valsartan (ARNI) vs enalapril: 20% KV smrtnost ili HF hospitalizacija 1990s 2000s 2010s CIBIS-II 2 (1999) 2,647 bolesnika bisoprolol (beta-blokator) vs placebo: 34% ukupna smrtnost CHARM-Added 4 (2003) 2,548 bolesnika Kandesartan (ARB) vs placebo: 15% KV smrtnost ili HF hospitalizacija EMPHASIS-HF 6 (2011) 2,737 bolesnika Eplerenon (MRA) vs placebo: 37% KV smrtnost ili HF hospitalizacija Percentages are relative risk reductions vs comparator ACEI=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; ARNI=ARNI=angiotensin receptor neprilysin inhibitor; BB=beta blocker; CV=cardiovascular; HF=heart failure; HFrEF=heart failure with reduced ejection fraction; MRA=mineralocorticoid receptor antagonist. See notes for definitions of study names 1. SOLVD Investigators. N Engl J Med 1991;325: ; 2. CIBIS-II Investigators. Lancet 1999;353:9 13;3. Granger et al. Lancet 2003;362:772 6; 4. McMurray et al. Lancet 2003;362: ; 5. Swedberg et al. Lancet 2010;376:875 85; 6. Zannad et al. N Engl J Med 2011;364:11 21; 7. McMurray et al. N Engl J Med 2014;371:
32 Optimalna medikamentna terapija Mortality SOLVD CONCENSUS -16 to -31% 2-17% bolesnika umire za vrijeme prve hospitalizacije 17-45% bolesnika umire unutar prve godine Oko 50% umire unutar prvih pet godina Diuretics Digoxin Hydralazine CIBIS II COPERNICUS -35% Ponikowski P et al. ESC Heart Failure 2014;1:4-25 RALES -30% ACE inhibitor Petogodišnji mortalitet: Ca. pluća: 83% Ca. dojke: 23% β-blockers + ACE inhibitor β-blockers + ACE Inhibitor + MRA COMPANION CARE HF -35% β-blockers + ACE + MRA + CRT-D SOLVD Investigators. N Engl J Med 1991 CIBIS-II Investigators. Lancet 1999 Granger et al. Lancet 2003 McMurray et al. Lancet 2003 Swedberg et al. Lancet 2010 Zannad et al. N Engl J Med 2011 McMurray et al. N Engl J Med 2014 PARADIGM HF -20% Svi karcinomi zajedno (pluća, kolorektalni, prostata, mokraćni mjehur): 58% Srčano zatajivanje: 59% Stewart S et al. Circ Cardiovasc Qual Outcomes 2010;3: ARNI + β-b + ACE + MRA
33 Učinak β-blokatora na mortalitet CIBIS II bisoprolol MERIT-HF metoprolol COPERNICUS carvedilol SENIORS nebivolol 2647 bolesnika LVEF 35% NYHA II-III 16 mjeseci praćenja 3991 bolesnika LVEF 40% 12 mjeseci praćenja 2289 bolesnika NYHA III-IV LVEF <25% 10.4 mjeseci praćenja 2128 bolesnika NYHA II-III Dob 70 godina Prosječna EF 36% 21 mjesec praćenja 34% RR za smrt 44% RR za naglu srčanu smrt 38% RR za KV smrt 34% RR smrt 41% RR za naglu srčanu smrt 35% RR za smrt 33% hospitalizacija radi popuštanja srca 14% RR za smrt ili hospitalizaciju radi popuštanja Bez značajnog utjecaja na ukupnu smrtnost
34 ACE inhibitori Smanjuju tlačno opterečenje srca, te utjeću na remodelaciju LK Smanjuju simptome srčanog popuštanja i broj hospitalizacija Smanjuju smrtnost Nuspojave: Kašalj, angio edem, hipotenzija ramipril, perindopril, trandolapril, enalapril
35 ACE inhibitori Smanjuju tlačno opterečenje srca, te utjeću na remodelaciju LK Smanjuju simptome srčanog popuštanja i broj hospitalizacija Smanjuju smrtnost Nuspojave: Kašalj, angio edem, hipotenzija ramipril, perindopril, trandolapril, enalapril
36 Samo u ciljnim dozama postiže se ovakav učinak 16% % Smanje enja smrtnos sti (ARR za 4,5%; srednje praćenje od 41,4 mjeseci) 23% (ARR za 3,0%; srednje praćenje od SOLVD 1 33,7 mjeseci) CHARM-Alternative 2 30% (ARR za 11,0%; srednje praćenje od 32% 24 mjeseci) RALES 4 (ARR za 5,5%; srednje praćenje od 1,3 godine) CIBIS-II 3
37 Doze lijekova u ZS
38 Optimizacija doze diuretika PREVISOKA DOZA Dehidracija Slabost Malaksalost Sinkope Pogoršanje bubrežne funkcije PRENISKA DOZA Pogoršanje funkcijskog statusa (NYHA klasa) Paroksizmalna noćna dispneja Pojava perifernih edema Dovodi do dolaska u HS i hospitalizacije NUŽNO JE POSTIZANJE OPTIMALNOG BALANSA
39 Optimizacija doze diuretika NUSPOJAVE Ototoksičnost tinitus i gubitak sluha (najčešće reverzibilno) Azotemija ne zahtjeva terapijske promjene, štoviše u bolesnika sa uznapredovalim HFrEF treba tolerirati više doze uree i kreatinina da se postigne ciljani diuretski učinak REZISTENCIJA Učinkovitost se smanjuje sa progresijom bolesti Zahtijeva povećanje doze i višestruko doziranje ili dodavanje druge linije diuretika RAZVOJ KARDIORENALNOG SINDROMA
40 Stupnjevi zatajivanja srca i mogućnosti liječenja sistoličkog zatajivanja srca Jessup et al. NEJM 2003
41 Novi lijekovi u kroničnom ZS
42 Sacubitril+valsartan (Entresto) Angiotenzinogen probnp sacubitril Angiotenzin I NT-proBNP BNP Vasodilation BP Sypathetic tone Aldosterpne levels Fibrosis Hypertrophy Natriuresis/diuresi s Neprilizin Incative fragments valsartan Angiotenzin II AT1 receptor Vasoconstriction BP Sypathetic tone Aldosterone levels Fibrosis Hypertrophy
43 Ponikowski P, et al. EHJ 2016
44 Diabetes+ heart failure = empagliflozin Empagliflozin selective inhibitor of the sodium glucose co-transporter-2 (SGLT-2) sodium glucose co-transporter-2 ( glucose) HbA1c BMI BP J. Samardžić - Suvremeni pristup u liječenju Liakos i praćenju A et al. bolesnika Diabetes s kroničnim Obes Metab zatajivanjem 2014;16:984- srca 93
45 Nedostatak željeza u ZS Ponikowski P, et al. EHJ 2016
46 IVABRADIN specifični inhibitor I f struje u SA čvoru Bez utjecaja na: Kontraktilitet Provodni sustav miokarda
47 SHIFT studija 6500 subjekata (NYHA II-IV, EF <35%) 90% BB, 84% ACE/ARB, 60% MRA
48 Lijekovi koje je preporučljivo izbjegavati Anti-aritmici Kardiodepresivni i proaritmični učinak Samo amiodaron i dofetilid su pokazali da nemaju negativni utjecaj na preživljenje Blokatori kalcijskih kanala Povečavaju broj kardiovaskularnih događaja i negativno utjeću na preživljenje Samo vazoselektivni su se pokazali sigurnima NSAIL Retencija soli i vode Smanjenje efikasnosti i povečanje nuspojava diuretika i ACE inhibitora
49 DIG studija Hospitalizacija radi pogoršanja HF P= subjekata (EF 45%) Mortalitet DIG Group. NEJM 1997.
50 Cilj liječenja je produžiti život, unaprijediti kvalitetu života i smanjiti troškove Potrebno je uvesti optimalnu medikamentnu terapiju što ranije Diuretik β Blokator ARNI ACE ARB MRA Ivabradin Digitalis Potrebno je titrirati doze lijekova do ciljnih doza
51 sgc-modulators (Cinaciguat, Riociguat, BAY ) Myosine Activators (omecamtiv mecarbil) ECE + NEP-Inhibitors (Daglutril) New Polypeptides (Relaxin) New Natriuretic Peptides (Ularitide, Nesiritide, CD-NP) AGE-Breakers (TRC 4185) RyR stabilizers (JTV-519, S107) Renin-Inhibitors (Aliskiren) Na+-K+ +SERCA-ATPase Metabolic modulators Inhibitors (Istaroxime) (Perhexiline, trimetazidine, ranolazine, GLP-1 agonists ) Aldosterone- Syntase-Inhibitors (LCI, FAD 286)
52 Uznapredovali stadij kroničnog srčanog popuštanja Bolesnici učestalo u bolnici Toleriraju minimalni napor i tegobe često imaju u mirovanju Intravenski diuretici Inotropni lijekovi (dopamin, dobutamin, levosimendan, milirinone)
53 Lijekovi u AZS pozitivni inotropi ili vazopresori ili oboje
54 Ne zaboraviti i zapustiti liječenje komorbiditeta Anemija Angina pektoris Astma/KOPB Bubrežno zatajivanje Dijabetes Depresija Hiperuricemija Hiperlipidemija Hipertenzija Srčana kaheksija OSA ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
55 Nefarmakološko liječenje ZS Revaskularizacija miokarda Operacija zalistaka Biventrikulska stimulacija resinkronizacijska terapija srca (CRT) Implantabilni kardioverter-defibrilatori (ICD) Transplantacija srca Mehanička potpora srcu srčane crpke
56
57 Implantable Cardioverter Defibrillator (ICD)
58 Cardiac resynchronization therapy (CRT) CRT-P/CRT-D is recommended in patients in NYHA III IV class who are symptomatic despite optimal medical therapy, and who have LVEF<35% and QRS prolongation (QRS width >120 ms) CRT is recommended to reduce morbidity or to prevent disease progression in patients in NYHA II class, who are symptomatic despite optimal medical therapy, who have a reduced EF (LVEF<35%) and QRS prolongation (QRS width >150 ms)
59 Opcije liječenja uznapredovalog (terminalnog) stadija srčanog popuštanja CILJ LIJEČENJA -Prebrođivanje do oporavka -Prebrođivanje do transplantacije -Prebrođivanje do daljnje terapije -Prebrođivanje do daljnje odluke IV TERAPIJA Diuretici Inotropi IABP NAPREDNE METODE LIJEČENJA KRATKOTRAJNE ECMO DUGOTRAJNE Impella TandemHear t -Destinacijska terapija HTx VAD
60 Liječenje uznapredovalog ZS Tandemheart HeartMate II LVAS SynCardia TAH
61
62 Indikacije za MCS Bridge to decision (BTD) Bridge to candidacy (BTC) Bridge to transplantation (BTT) Bridge to recovery (BTR) Destination therapy (DT) Uporaba MCS-a kod bolesnika s akutnim rezistentnim cirkulatornim kolapsom u neposrednom riziku smrti dok se ne učini cjelovita klinička porcjena i evaluiraju dodatne opcije liječenja. Uporaba MCS-a kako bi se poboljšala funkcija ciljnih organa i bolesnika učinilo pogodnim kandidatom za transplantaciju. Uporaba MCS kod bolesnika koji su kandidati za transplantaciju srca, ali ne mogu dočekati transplantaciju bez mehaničke potpore. Uporaba MCS-a dok se intrinzička funkcija srca ne oporavi dovoljno da se odstrani MCS. Dugoročna uporaba MCS kao alternativa za transplantaciju srca kod bolesnika s uznapredovalim popuštanjem srca koji nisu kandidati za transplantacijsko liječenje. ESC Guidelines for the diagnosis and treatment of acute and chronic heart fail
63 Komplikacije kod bolesnika s VAD-om Komplikacije % bolesnika na VAD-u Bubrežna disfunkcija 56 Krvarenje 48 Infekcije 45 Neurološka disfunkcija 27 Tromboembolijski događaj 12 Mehanički kvar 1 J Thorac Cardiovasc Surg 2001;122:
64 Prebivališta bolesnika s ugrađenim trajnim MCS-om u KBC Zagreb
65 Bolesnici s kroničnim ZS
66 Transplantacija srca zlatni standard
67 Adult and Pediatric Heart Transplants Number of Transplants by Year and Location 2016 JHLT Oct; 35(10): NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide.
68 Heart transplantation rates in Europe 2015 INTERNATIONAL FIGURES ON ORGAN, TISSUE & HEMATOPOIETIC STEM CELL DONATION & TRANSPLANTATION ACTIVITIES. DOCUMENTS PRODUCED BY THE COUNCIL OF EUROPE EUROPEAN COMMITTEE (PARTIAL AGREEMENT) ON ORGAN TRANSPLANTATION (CD-P-TO). YEAR 2015
69 Adult and Pediatric Heart Transplants Average Center Volume (Transplants: January 2009 June 2015) 2016 JHLT Oct; 35(10):
70 Spiroergometrija VO2 maks 12 ml/kg/min (uz betablokator) VO2 maks 14 ml/kg/min < 50 god: < 50% predviđene VO2 maks. VE/VCO2 35
71 Swan-Ganz kateterizacija vazoreaktivni test: spap 50 mmhg ILI TPG 15 mmhg ILI PVR > 4 Wood
72 Dob > 70 godina BMI 35 kg/m2 DM2 s teškim oštećenjem ciljnih organa egfr < 30 ml/min/1.73 m2 Teška simptomatska cerebrovask. bolest Teška periferna arterijska bolest Aktualni nikotizam, psihosocijalni status,...
73 Transplantacija srca u Hrvatskoj
74 Liječenje ZS Ponikowski P, et al. EHJ 2016
75 Maggioni AP et al., Eur J Heart Fail 2013
76 Samo u ciljnim dozama postiže se ovakav učinak 16% % Smanje enja smrtnos sti (ARR za 4,5%; srednje praćenje od 41,4 mjeseci) 23% (ARR za 3,0%; srednje praćenje od SOLVD 1 33,7 mjeseci) CHARM-Alternative 2 30% (ARR za 11,0%; srednje praćenje od 32% 24 mjeseci) RALES 4 (ARR za 5,5%; srednje praćenje od 1,3 godine) CIBIS-II 3
77 Multidisciplinarni tim Dieticians Physiotherapis ts Psychologists Pharmacists HF cardiologists HF nurses Palliative care General practitioners Social workers Ponikowski P, et al. EHJ 2016
78 Palijativna skrb koncept primjene European Journal of Heart Failure Volume 11, Issue 5, pages , 22 APR 2009 DOI: /eurjhf/hfp041
79 Ključne komponente palijativne njege u bolesnika sa zatajivanjem srca Fokus na poboljšavanju i/ili zadržavanju kvalitete života bolesnika i njegove obitelji koliko je god moguće dok je živ Često procijenjivanje simptoma zatajivanja srca i komorbiditeta i olakšavanje istih Dostupnost psihološke i duhovne potpore prema potrebi Unaprijed isplanirati njegu uzimajući u obzir želje bolesnika Eur J Heart Fail Aug;18(8):
80 Kod kojih bolesnika sa zatajivanjem srca razmotriti terminalnu palijativnu njegu? Bolesnici s progresivnim funkcionalnim propadanjem (fizičkim i mentalnim) koji su ovisni o drugima u većini svakodnevnih aktivnosti Bolesnici s teškim simptomima i slabom kvalitetom života usprkos optimalnom liječenju Bolesnici koji su učestalo hospitalizirani zbog akutizacije zatajivanja srca Bolesnici koji nisu kandidati za napredne metode liječenja Bolesnici s kardijalnom kaheksijom Bolesnici koji su klinički procijenjeni da su blizu kraja života Eur J Heart Fail Aug;18(8):
81 Palijativna skrb teškoće u bolesnika sa ZS Refraktorni multipli simptomi Komunikacija Donošenje odluka Nepredvidljivost stanja Rekurentne egzacerbacije Teško procijeniti terminalnu fazu Visoka prevalencija NSS Komorbiditeti
82 Palijativna skrb paramedicinske teškoće u ZS Želje bolesnika Potrebe obitelji Nedovoljna osvještenost potrebe i koristi palijativne skrbi Kultura stanovništva Neuređen sustav
83 Ne zaboraviti provjeriti i uvijek se pitati... Je li pogoršanje kroničnog zatajivanja srca reverzibilno? Ishemija Loša suradljivost Tahiaritmija Bradiaritmija Valvularna regurgitacija Plućna embolija Infekcija Bubrežna insuficijencija
84 Agenda Definicija i epidemiologija ZS Klinički sindromi Dijagnostika Liječenje Tips and tricks Zaključak
85 Tips & tricks NTproBNP interpretirati racionalno Kronično ZS kod posjeta provjeriti treba li titrirati terapiju Nositelji ICD-a kod repetitivnog uključivanja pri punoj svijesti staviti običan magnet iznad uređaja (i kod operacija) ICD neće pomoći u simptomima MCS bolesnici jako važan INR, njega provodnika MCS bolesnici uglavnom bez palpabilnog pulsa
86 Tips & tricks HTX bolesnici cijepiti protiv gripe, razmotriti vraćanje na posao Sakubitril/valsartan obiteljski liječnik može produžiti terapiju više od 6 mjeseci bez kardiologa Hipotenzivan bolesnik sa ZS infuzije volumenom mogu štetiti Izbjegavati CCB kod bolesnika sa ZS Digoksin samo kod bolesnika sa značajnim ZS i brzom FA Bolesnika sa ZS uputiti na evaulaciju u ambulantu za zatajivanje srca
87 Agenda Definicija i epidemiologija ZS Klinički sindromi Dijagnostika Liječenje Tips and tricks Zaključak
88 Glavne poruke Zatajivanje srca je vrlo važan klinički sindrom s uglavnom vrlo lošom prognozom bolesti Važna je uloga svih dijelova zdravstvenog sustava koji sudjeluju u skrbi za ove bolesnike Važno je za bolje ishode titrirati terapiju u kroničnom popuštanju do maksimalnih i/ili podnošljivih doza Pravovremeno i adekvatno zbrinjavanje akutnih pogoršanja kao i pravovremeno upućivanje na evaluaciju u tercijarni centar je krucijalno da se dostupni resursi optimalno upotrebljavaju
89 Hvala na pažnji!
Sacubitril/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 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 informationMEDICAL THERAPY IN HEART FAILURE
MEDICAL THERAPY IN HEART FAILURE Dr Lim Choon Pin MBBS, MRCP (UK), MMed (Int Med), FAMS, FESC, FACC Consultant Cardiologist, The Heart and Vascular Centre Heart Failure, Heart Transplant, Mechanical Circulatory
More informationECG in CRT patients & novel HF therapies. Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος
ECG in CRT patients & novel HF therapies Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος Dr. Konstantinou has received grants from Medtronic Is identification
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 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 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 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 informationOptimal Management of Heart Failure
Curriculum Vitae Name : Prof. DR. Dr. Idrus Alwi SpPD, K-KV, FACC, FESC, FAPSIC, FINASIM, FACP. Current Position : Professor of Internal Medicine Faculty of Medicine UI Medical Student : Faculty of Medicine
More information2017 Summer MAOFP Update
2017 Summer MAOFP Update. Cardiology Update 2017 Landmark Trials Change Practice Guidelines David J. Strobl, DO, FNLA Heart Failure: Epidemiology More than 4 million patients affected 400,000 new cases
More informationUNMET NEEDS IN THE MANAGEMENT OF HEART FAILURE
UNMET NEEDS IN THE MANAGEMENT OF HEART FAILURE By Mohammed Sadaka, MD ALEXANDRIA UNIVERSITY 2 Presentation Title Presenter Name Date Subject Business Use Only 1 HF is a complex syndrome involving multiple
More informationNeurohormonal blockade: is there still room to go?
Neurohormonal blockade: is there still room to go? M.Birhan YILMAZ, MD, FESC, FACC, FHFA Professor of Cardiology, Cumhuriyet University Sivas, TURKEY President of Heart FailureWG of Turkish Society of
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 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 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 informationDrugs acting on the reninangiotensin-aldosterone
Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School
More informationHeart Failure: Current Management Strategies
Heart Failure: Current Management Strategies CSHP Fall Education Session- September 30th, 2017 Carolyn MacKinnon & Tamara Matchett BscPharm, ACPR Candidates Objectives 1. Describe the pathophysiology &
More informationRAAS blocker + B Blocker Troubleshooting
RAAS blocker + B Blocker Troubleshooting Heart Failure ECHO Clinic Virtual Heart Failure Consultation and Education Prof Ken McDonald & Dr. Patricia Campbell 13 th March 2017 HF activates 3 neurohormonal
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 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 informationContemporary Advanced Heart Failure Therapy
Contemporary Advanced Heart Failure Therapy Andrew Boyle, MD Professor of Medicine Medical Director of Advanced Heart Failure Thomas Jefferson University Philadelphia, PA Audience Response Question 40
More informationWomen s Heart Health: Holistic Approaches Throughout the Lifetime - Key Differences in Heart Failure in Women
Women s Heart Health: Holistic Approaches Throughout the Lifetime - Key Differences in Heart Failure in Women C. Noel Bairey Merz MD Medical Director and Barbra Streisand Women s Heart Center Preventive
More informationBeyond ACE-inhibitors for Heart Failure. Jacob Townsend, MD NCVH Birmingham 2015
Beyond ACE-inhibitors for Heart Failure Jacob Townsend, MD NCVH Birmingham 2015 % Decrease in Mortality Current Therapy HFrEF 0% Angiotensin receptor blocker ACE inhibitor Beta blocker Mineralocorticoid
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 informationANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITORS IN HEART FAILURE FROM CHD
ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITORS IN HEART FAILURE FROM CHD Karen Stout, MD FACC Professor, Medicine/Pediatrics University of Washington Seattle, WA USA No disclosures Case 35 year old man with
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 informationTerapia Farmacologica della Insufficienza Cardiaca Cronica: è in arrivo una rivoluzione? Gennaro Cice
Terapia Farmacologica della Insufficienza Cardiaca Cronica: è in arrivo una rivoluzione? Gennaro Cice Cattedra di Cardiologia Seconda Università di Napoli 60 CONGRESSO NAZIONALE SIGG NAPOLI, 25-28 NOVEMBRE
More informationHFrEF and Neurohormonal Systems
HFrEF and Neurohormonal Systems Normal Control of the Circulation: Neurohumoral Balance Vasoconstrictor Salt and H 2 O retaining Vasodilator Diuretic Richard Troughton CSANZ Breakfast Symposium 15 June
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 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 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 informationHeart Failure. GP Update Refresher 18 th January 2018
GP Update Refresher 18 th January 2018 Heart Failure Dr. Alexander Lyon Senior Lecturer and Consultant Cardiologist Clinical Lead in Cardio-Oncology Royal Brompton Hospital, London UK President of British
More informationState-of-the-Art Management of Chronic Systolic Heart Failure
State-of-the-Art Management of Chronic Systolic Heart Failure Michael McCulloch, MD 17 th Annual Cardiovascular Update Intermountain Medical Center December 16, 2017 Disclosures: I have no financial disclosures
More informationEntresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction
Cardio-Metabolic Franchise Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Randy L Webb, PhD Rutgers Workshop October 21, 2016 Heart
More informationHeart Failure New Drugs- Updated Guidelines
Heart Failure New Drugs- Updated Guidelines Eileen Handberg, PhD, ANP-BC, FAHA, FACC Professor of Medicine Division of Cardiovascular Medicine University of Florida Disclosures 1. 3 2. 6 3. 8 4. 11 Dunlay
More informationHeart Failure. Optimising treatment and balancing co-morbidity in the community. Andrew Ludman Cardiologist
Heart Failure Optimising treatment and balancing co-morbidity in the community Andrew Ludman Cardiologist What is heart failure? A structural cardiac abnormality leading to failure of the heart to provide
More informationHeart Failure (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis. More malignant than most cancers
Patients in US (millions) Heart Failure (HF): Scope of the Problem 1 4 2 3.5 4. 1. 1991 21 237 US prevalence*: 5. million US annual incidence: 7, Annual mortality: 22,754 5-1% depending on severity Cost:
More informationA New Future In Heart Failure (Should we reshuffle the deck?)
A New Future In Heart Failure (Should we reshuffle the deck?) DR. HEMANT SAHA, MD, MRCP(UK) AGA KHAN UNIVERSITY HOSPITAL, NAIROBI Disclosures Nothing to disclose. Objectives 1. Historical Perspectives
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 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 informationSystolic Dysfunction Clinical /Hemodynamic Guide for Management From Neprilysin Inhibitors to Ivabradine
Systolic Dysfunction Clinical /Hemodynamic Guide for Management From Neprilysin Inhibitors to Ivabradine Donna Mancini MD Choudhrie Professor of Cardiology Columbia University Speaker Disclosure Amgen
More informationNew Pharmacological Developments In Heart Failure
New Pharmacological Developments In Heart Failure Diego Delgado, MD, FACC, MSc Associate Professor Site Director, Division of Cardiology Toronto General Hospital Heart Failure and Transplant Program University
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 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 informationWhat s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital
What s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital Disclosures I have no current or past relationships with commercial entities Learning objectives
More informationNew Trials. Iain Squire. Professor of Cardiovascular Medicine University of Leicester. Chair, BSH
New Trials Iain Squire Professor of Cardiovascular Medicine University of Leicester Chair, BSH BSH Heart Failure Day for Revalidation and Training 2017 Presentation title: New Trials Speaker: Iain Squire
More informationOptimal blockade of the Renin- Angiotensin-Aldosterone. in chronic heart failure
Optimal blockade of the Renin- Angiotensin-Aldosterone Aldosterone- (RAA)-System in chronic heart failure Jan Östergren Department of Medicine Karolinska University Hospital Stockholm, Sweden Key Issues
More informationHeart Failure (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis. More malignant than cancer
Patients in US (millions) Heart Failure (HF): Scope of the Problem 1 8 6 4 2 3.5 4.8 1. 1991 21 237 US prevalence*: 5.8 million US annual incidence: 67, Annual mortality: 282,754 5-1% depending on severity
More informationHEART FAILURE: PHARMACOTHERAPY UPDATE
HEART FAILURE: PHARMACOTHERAPY UPDATE 3 HEART FAILURE REVIEW 1 5.1 million x1.25 = 6.375 million 40 years old = MICHAEL F. AKERS, PHARM.D. CLINICAL PHARMACIST CENTRACARE HEALTH, ST. CLOUD HOSPITAL HF Diagnosis
More informationLITERATURE REVIEW: HEART FAILURE. Chief Residents
LITERATURE REVIEW: HEART FAILURE Chief Residents Heart Failure EF 40% HFrEF Problem with contractility EF 40-50% HFmrEF EF > 50% HFpEF Problem with filling/relaxation RISK FACTORS Post MI HTN DM Obesity
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 informationHF TREATMENT PROGRESS
Mortality Digoxin, Diuretics, Hydralazi ne HF TREATMENT PROGRESS SOLVD CONCENSUS -16 to -31 % + ACE-I CIBIS II COPERNICUS -35 % + b- blockers RALES -22 % COMPANION & CARE HF -36 % + Aldostero ne Inhibitors
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 informationDr Dinna Soon. Consultant Cardiologist, Department of Cardiology. GP symposium 2 April 2016
Dr Dinna Soon Consultant Cardiologist, Department of Cardiology GP symposium 2 April 2016 Case presentation 76 years old male, chronic smoker, hypertension, previous MI 3/7 SOB and chest tightness BP
More informationHeart Failure (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis. More malignant than most cancers
Evidence-Based Approaches to the Management of Heart Failure: Reducing Hospitalization and Improving Patient Outcomes Eldrin F. Lewis, MD, MPH Director of Cardiovascular Clerkship Brigham and Women s Hospital
More informationACE inhibitors: still the gold standard?
ACE inhibitors: still the gold standard? Session: Twenty-five years after CONSENSUS What have we learnt about the RAAS in heart failure? Lars Køber, MD, D.Sci Department of Cardiology Rigshospitalet University
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 informationHow Do You Mend a Broken Heart: The New Agents to Treat HF Paradigm Shift or Just the Same Old Drugs?
How Do You Mend a Broken Heart: The New Agents to Treat HF Paradigm Shift or Just the Same Old Drugs? Gregg C. Fonarow, MD FACC, FAHA, FHFSA Co-Chief UCLA Division of Cardiology Director, Ahmanson-UCLA
More information2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much?
2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much? Dr. Shelley Zieroth University of Manitoba @ShelleyZieroth @CanHFSociety Disclosures Consulting/Advisory Board: Amgen, Astra
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 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 informationUpdates in Heart Failure (HF) 2016: ACC / AHA and ESC
Updates in Heart Failure (HF) 2016: ACC / AHA and ESC Patrick McBride, MD, MPH Professor of Medicine & Family Medicine, UW School of Medicine and Public Health Special thanks to: Clyde W. Yancy, MD, MSc
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 informationNeprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary
Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1 Indication Entresto Reduce the risk of cardiovascular (sacubitril/valsartan) death
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 informationLearning Objectives. Heart Failure (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis
7:5 :5 am Update in Heart Failure SPEAKER Orly Vardeny, PharmD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Orly Vardeny, PharmD, MS: Advisory Board
More informationCKD Satellite Symposium
CKD Satellite Symposium Recommended Therapy by Heart Failure Stage AHA/ACC Task Force on Practice Guideline 2001 Natural History of Heart Failure Patients surviving % Mechanism of death Sudden death 40%
More information2/15/2017. Disclosures. Heart Failure = Big Problem. Heart Failure Update Reducing Hospitalizations and Improving Patient Outcomes 02/18/2017
Heart Failure Update Reducing Hospitalizations and Improving Patient Outcomes 02/18/2017 Julio A. Barcena, M.D. South Miami Heart Specialists Disclosures I have no relevant commercial relationships to
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 informationHeart Failure is the Fastest Rising Cardiovascular Condition in Canada. HF is a Progressive Condition with High Morbidity and.
Function & quality of life (QoL) Approved HF agents 1.Management of Heart Failure Patients in Ontario: Recommendations from Best Practice, April 213, *Ross et al. Treating the right patient at the right
More informationChronic Heart Failure Therapies: Transforming the Landscape
Chronic Heart Failure Therapies: Transforming the Landscape Dr. Nadia Giannetti Chief of Cardiology Medical Director, Heart Failure and Heart Transplant Program McGill University Health Center Conflict
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 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 informationWhat Next? Management of Heart Failure with Reduced Ejection Fraction What Does the Evidence Show Us?
65 yr WM presents for followup of HFrEF. Management of Heart Failure with Reduced Ejection Fraction What Does the Evidence Show Us? NYHA II-III, HFH 6 mo ago. Prior CABG, DM and HTN. LVEF 30%. Meds: lisinopril
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 informationLCZ696: LA NUOVA RIVOLUZIONE NELLA TERAPIA DELLO SCOMPENSO CARDIACO. Dario Leosco Università di Napoli Federico II
LCZ696: LA NUOVA RIVOLUZIONE NELLA TERAPIA DELLO SCOMPENSO CARDIACO Dario Leosco Università di Napoli Federico II Projected changes in cardiovascular diseases CVD Deaths Increase 33% CVD DALYS 22% CAD
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 informationOverview & Update on the Utilization of the Natriuretic Peptides in Heart Failure
June 28, 2016 Overview & Update on the Utilization of the Natriuretic Peptides in Heart Failure Linda C. Rogers, PhD, DABCC, FACB. Agenda Overview of the Natriuretic Peptides and Efficacy studies Similarities
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 informationΝέες θεραπευτικές προσεγγίσεις για τους ασθενείς με καρδιακή ανεπάρκεια και μειωμένο κλάσμα εξωθήσεως (HFrEF).
Νέες θεραπευτικές προσεγγίσεις για τους ασθενείς με καρδιακή ανεπάρκεια και μειωμένο κλάσμα εξωθήσεως (HFrEF). ΧΑΡΑΛΑΜΠΟΣ Ι. ΚΑΡΒΟΥΝΗΣ Καθηγητής Καρδιολογίας Α.Π.Θ. Disclosures Teaching grants and honoraria
More informationCongestive Heart Failure 2015
Definition Congestive Heart Failure 215 JP Mehegan/ Mercy Cardiology n Cardiac failure; Congestive heart failure; Chronic heart failure (synonyms) n When the heart is unable to pump sufficiently and at
More informationA new class of drugs for systolic heart failure: The PARADIGM-HF study
INTERPRETING KEY TRIALS CME CREDIT EDUCATIONAL OBJECTIVE: Readers will describe the mechanism and use of angiotensin receptor-neprilysin inhibitors in heart failure MARWA A. SABE, MD, MPH Department of
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 informationDiagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham
Diagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Chronic heart failure
More informationThe Management of Heart Failure A PARADIGM Shift?
The Management of Heart Failure A PARADIGM Shift? Richard Clarens, PharmD UND School of Medicine & Health Sciences Altru Family Medicine Residency NDSU College of Pharmacy, Nursing, & Allied Sciences OBJECTIVES
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 informationSessions Formació Continuada en Cardiologia i Especialitats Relacionades Cardioactualitat: Noves estratègies terapèutiques en el maneig de la IC
Sessions Formació Continuada en Cardiologia i Especialitats Relacionades Cardioactualitat: Noves estratègies terapèutiques en el maneig de la IC J. Comin Colet Cap de Secció del Servei de Cardiologia i
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 informationDamien Logeart. Disclosure: none
Damien Logeart Disclosure: none 13/1/211 HEART FAILURE AND MYOCARDIOPATHIES Best of 21 Damien Logeart Hôpital Lariboisière, Paris Service Cardiologie INSERM U942 Cliquez pour modifier le style des sous-titres
More informationPractical considerations for the use of ARNI in CHF: clinical cases. J. Parissis, Heart Failure Clinic, University of Athens, Athens, Greece
Practical considerations for the use of ARNI in CHF: clinical cases J. Parissis, Heart Failure Clinic, University of Athens, Athens, Greece Disclosures: Research grants and honoraria for lectures from
More informationHeart Failure Update. Bibiana Cujec MD May 2015
Heart Failure Update Bibiana Cujec MD May 2015 Disclosures Participation in clinical trial GUIDE IT (BNP in management of HF) Plan Review of new trials/ccs guidelines Management of heart failure: cases
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 informationRationale and Practical Aspects of Sacubitril- Valsartan and Ivabradine Use in Heart Failure Patients
Rationale and Practical Aspects of Sacubitril- Valsartan and Ivabradine Use in Heart Failure Patients Javed Butler, MD, MPH, MBA Patrick H. Lehan Professor of Medicine Professor of Physiology Chairman,
More informationClinical Pearls Heart Failure Cardiology/New Drugs
Clinical Pearls Heart Failure Cardiology/New Drugs Friday, September 9 th, 2016 Heidi Burres, PharmD, BCACP MTM Pharmacist Fairview Pharmacy Services Thank You to XYZ Event Sponsor(s): Wi-fi Information:
More informationChallanges in evaluation of coronary artery disease in patients with diabetes
Challanges in evaluation of coronary artery disease in patients with diabetes Branko Beleslin, MD, PhD, FESC, FACC Cardiology Clinic, Clinical centre of Serbia Medical faculty, University of Belgrade Scope
More informationHeart Failure Therapies State of the Art: 2018
Heart Failure Therapies State of the Art: 2018 Andrew J. Sauer MD Associate Professor of Medicine Division Director Advanced Heart Failure Therapies & Cardiac Transplantation University of Kansas Medical
More informationHeart Failure: Guideline-Directed Management and Therapy
Heart Failure: Guideline-Directed Management and Therapy Guideline-Directed Management and Therapy (GDMT) was developed by the American College of Cardiology and American Heart Association to define the
More informationManagement of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA
Management of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA Declaration of potential conflict of interests Type of job or financial support Salary Ordinary funds Position in
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More information