Updates in the Management of Cardiovascular Diseases. Anna Nogid, PharmD, BCPS Associate Professor of Pharmacy Practice LIU Pharmacy
|
|
- Brandon Anderson
- 6 years ago
- Views:
Transcription
1 Updates in the Management of Cardiovascular Diseases Anna Nogid, PharmD, BCPS Associate Professor of Pharmacy Practice LIU Pharmacy
2 Objectives Discuss updates in treatment recommendations for patients with cardiovascular disorders Develop a treatment plan for a patient with cardiovascular disorders Provide patient education with regard to disease state and drug therapy for patients with CV disorders
3 Prevalence of CV Disease in Adults Go A S et al. Circulation. 2014;129:e28-e292 Copyright American Heart Association, Inc. All rights reserved.
4 Deaths and Hospital Discharges Attributable to CV Disease Deaths Hospital Discharges Go A S et al. Circulation. 2014;129:e28-e292 Copyright American Heart Association, Inc. All rights reserved.
5 Leading Diagnoses for Direct Health Expenditures Go A S et al. Circulation. 2014;129:e28-e292 Copyright American Heart Association, Inc. All rights reserved.
6 Updates in CV Disease Timeline June 2013 Heart failure October 2013 Secondary prevention of atherosclerotic disease November 2013 High blood pressure High cholesterol ASCVD risk assessment February 2014 JNC 8 March 2014 Atrial fibrillation May 2014 secondary stroke prevention
7 Managing High Blood Pressure
8 Awareness, Treatment, and Control of High Blood Pressure Go A S et al. Circulation. 2014;129:e28-e292 Copyright American Heart Association, Inc. All rights reserved.
9 What s New in JNC 8? No definition for hypertension Increased SBP threshold for drug treatment initiation in patients > 60 years of age Similar treatment goals defined for most hypertensive patients Emphasis on lifestyle modifications Recommended selection among 4 specific mediation classes Specific medication classes recommended for racial, diabetic, and CKD patient groups
10 Treatment goals General population Age 60 years or older: < 150mmHg/90 mmhg Age < 60 years: < 140mmHg/ 90 mmhg CKD: < 140 mmhg/90 mmhg Diabetes: < 140mmHg/90mmHg
11 Lifestyle Modifications Modification Weight reduction ~ SBP 5-20 mm Hg/10kg Attain & maintain BMI < 25 kg/m 2 Adopt DASH eating plan Fruits/vegetables Low-fat dairy products Reduce saturated fat & cholesterol Physical activity > 30 min/day most days of the week Dietary sodium restriction < 2.4g/day (< 1.5 g/day) Moderate alcohol consumption < 2 drinks/d (men); < 1 drink/d (women) 8-14 mm Hg 4-9 mm Hg 2-8 mmhg 2-4 mm Hg Go AS, et al. Hypertension 2014;63;
12 Approach to Treatment: JNC 8 JAMA. 2014;311(5): doi: /jama
13 Approach to Treatment: JNC 8 (cont) JAMA. 2014;311(5): doi: /jama
14 Approach to dosing Initiate with 1 or 2 agents from recommended drug class If goal BP is not reached within 1 month, increase dose or add another agent Continue increasing the dose until goal BP is attained Consider alternative antihypertensive agents if needed Avoid ACEI + ARB whenever possible
15 Adverse Effects of Commonly Utilized Blood-Pressure Lowering Agents Class DHP CCB Non-DHP CCB Diuretics ACEI ARB Adverse effects Peripheral edema, flushing, reflex tachycardia Constipation (verapamil), bradycardia Electrolyte disturbances, hyperuricemia, hyperglycemia, hyperlipidemia Hyperkalemia, SCr, cough, angioedema, hypotension Hyperkalemia, SCr, angioedema, hypotension
16 Patient Education Blood pressure monitoring Every 2-4 weeks until controlled, then every 3-6 months Self-monitoring for select patients Importance of adherence Lifestyle modifications
17 Summary Higher BP goals for most patients Beta blockers are no longer preferred initial agents in the general population Main objective is to attain and maintain goal BP Combine drug therapy with lifestyle modifications
18 Patient Profile 18 Patient Name: BE Address: 75 Dekalb Ave, Brooklyn, NY Age: 62 Height: 5 8 Weight: 251 lb Sex: F Phone: (800) Medication Profile Date Rx No. Physician Drug/Strength Qty Sig Refills 5/ Davis Carvedilol 25mg 60 1 bid 2 5/ Davis Furosemide 40mg 30 1 daily 2 5/ Davis Fosinopril 40mg 30 1 daily 1 5/ Wonder Glipizide XL 10mg 30 1 daily 4 5/ George Tramadol 50mg 60 1 bid 1 4/ Davis Carvedilol 12.5mg 60 1 bid 2 4/ Davis Furosemide 40mg 60 1 daily 2 4/ Davis Fosinopril 40mg 30 1 daily 2 4/ Wonder Glipizide XL 10mg 30 1 daily 5 4/ George Tramadol 50mg 60 1 bid 2
19 Patient Case: Additional Information Ethnicity: Caucasian PMHx: DM x 15 years; CAD x 10 years (MI in 1999 and 2001), heart failure, and osteoarthritis Social Hx: tobacco use OTC: aspirin 81mg daily, ibuprofen PRN BP: 144mmHg/85mmHg
20 Patient Case According to JNC 8, what is the BP target for this patient? < 140/90 mmhg What recommendations for therapy, if any, would you make in this patient? Provide patient education with regard to hypertension and drug therapy for this patient
21 Managing Elevated Cholesterol
22 What s New in 2013 Guidelines? Focus on reduction of cardiovascular risk: 4 statin benefit groups A new perspective on treatment goals Global risk assessment for primary prevention Safety recommendations
23 4 Defined Statin Benefit Groups Clinical ASCVD LDL >190 mg/dl Age years + diabetes + LDL mg/dl Age ASCVD 10 year risk of > 7.5% ASCVD = ACS, history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial disease of atherosclerotic origin.
24 ASCVD Risk Assessment Use Pooled Cohort Risk Assessment Equations in non- Hispanic patients between age of years Risk factors considered Sex Age Race Total Cholesterol HDL Systolic BP Treated for HBP Diabetes Smoker
25 Cholesterol Targets High-Intensity (LDL-C reduction > 50%) Age < 75 years + clinical ASCVD Age 40 75years + diabetes + ASCVD risk > 7.5% LDL-C > 190 mg/dl ASCVD > 7.5% Moderate-Intensity (LDL-C reduction 30 50%) Age > 75 years + clinical ASCVD Age years + diabetes and ASCVD risk < 7.5%
26 Intensity of Statin Therapy High-intensity Moderate-intensity Low-intensity Daily dose lowers LDL-C on average, by ~ > 50% Atorvastatin 40 80mg Rosuvastatin 20-40mg Daily dose lowers LDL-C on average, by 30-50% Atorvastatin 10 20mg Rosuvastatin 5-10mg Simvastatin 20 40mg Pravastatin 40 80mg Lovastatin 40mg Fluvastatin 40mg BID Pitavastatin 2 4mg Daily dose lowers LDL-C on average, by < 30% Simvastatin 10mg Pravastatin 10 20mg Lovastatin 20mg Fluvastatin 20 40mg Pitavastatin 1mg Selection of statin and dose should be based on patient characteristics, level of ASCVD risk, patient preference, and potential for adverse drug reactions and drug interactions
27 Comparison of Statins Variable Rosuva- Atorva- Simva - Prava- Lova- Fluva- Pitava- Half-life (hrs) Protein Binding (%) Active Metab > >95 >90 99 Yes Yes Yes No Yes No No Solubility Hydro- Lipo- Lipo- Hydro- Lipo- Lipo- Lipo- CYP 450 isoenzyme 2C9 2C19 3A4 3A A4 2C9 --- Adapted by Rosenson RS. The Am J of Med. 2004;116:
28 Statin Safety Concerns Hepatotoxicity Muscle adverse effects Myalgias = muscle aches, soareness, stiffness, tenderness, cramps Myopathy = muscle weakness Myositis = muscle inflammation; pain + CK elevation Myonecrosis +/- myoglobinuria or AKI Increased blood sugar? Cognitive adverse effects? Rosenson RS, et. al. J Clin Lipid. 2014;8:s58-71
29 Monitoring of Statin Therapy Liver enzymes at baseline and as clinically indicated thereafter Routine monitoring of CK and hepatic transaminase levels is not recommended
30 Nonstatin Therapy Drug Class Effects (% change) Safety Niacin LDL (15-30), HDL (15-35) TG (20-50) Fibric Acids LDL (5-20), HDL (10-35) TG (20-50) Flushing, BG, UA, GI upset, hepatotoxicity Dyspepsia, gallstones, myopathy Bile Acid sequestrants Cholesterol absorption inhibitor Omega-3-acid ethyl esters LDL (15 30%), HDL (3-5%), no significant effect on TG LDL( 14-18), HDL (1-3) TG (2) LDL, HDL, TG (17-48) GI distress, many DDI Headache, GI distress GI distress
31 Summary No longer use targets for cholesterol levels Identify patients at risk Know the 4 high risk groups Use medications proven to reduce risk, ie statins Encourage healthy lifestyle Understand that questions and concerns remain
32 Patient Profile 32 Patient Name: BE Address: 75 Dekalb Ave, Brooklyn, NY Age: 62 Height: 5 8 Weight: 251 lb Sex: F Phone: (800) Medication Profile Date Rx No. Physician Drug/Strength Qty Sig Refills 5/ Davis Carvedilol 25mg 60 1 bid 2 5/ Davis Furosemide 40mg 30 1 daily 2 5/ Davis Fosinopril 40mg 30 1 daily 1 5/ Wonder Glipizide XL 10mg 30 1 daily 4 5/ George Tramadol 50mg 60 1 bid 1 4/ Davis Carvedilol 12.5mg 60 1 bid 2 4/ Davis Furosemide 40mg 60 1 daily 2 4/ Davis Fosinopril 40mg 30 1 daily 2 4/ Wonder Glipizide XL 10mg 30 1 daily 5 4/ George Tramadol 50mg 60 1 bid 2
33 Patient Case: Additional Information Ethnicity: Caucasian PMHx: DM x 20 years; CAD x 15 years (MI in 1999 and 2001), heart failure, and osteoarthritis Social Hx: tobacco use OTC: aspirin 81mg daily, ibuprofen PRN BP: 144mmHg/85mmHg Total cholesterol = 195 mg/dl LDL = 120 mg/dl HDL = 45 mg/dl TG = 150 mg/dl
34 Patient Case According to AHA 2013 Document, would this patient benefit from statin therapy? If yes, recommend an appropriate lipid lowering regimen for this patient. Yes. Patient falls into a statin benefit group High-intensity statin: atorvastatin 40 80mg daily or rosuvastatin 20 40mg daily Provide patient education with regard to high cholesterol and drug therapy for this patient
35 Heart Failure Guidelines Update
36 What s new? Emphasis placed on education and transitions of care Broadened indication for the use of aldosterone antagonist Routine use of ACEI + ARB + ALDO ANT is harmful
37 Treatment Goals Identify and control risk factors for HF Improve quality of life Relieve/reduce signs and symptoms Prevent/minimize hospitalizations Slow progression of the disease process Prolong survival
38 Definition of Heart Failure Classification Ejection Description Fraction Heart Failure with Reduced Ejection Fraction (HFrEF) 40% Also referred to as systolic HF Heart Failure with Preserved Ejection Fraction (HFpEF) 50% Also referred to as diastolic HF. a. HFpEF, Borderline 41% - 49% b. HFpEF, Improved >40% A subset of patients with HFpEF previously had HFrEF with improvement or recovery in EF.
39 Classification of Heart Failure A B C ACCF/AHA Stages of HF At high risk for HF but without structural heart disease or symptoms of HF. Structural heart disease but without signs or symptoms of HF. Structural heart disease with prior or current symptoms of HF. I I NYHA Functional Classification No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF. No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF. II Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF. D Refractory HF requiring specialized interventions. III IV Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF. Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.
40 Non-Pharmacologic Therapy 40 Discontinue drugs that may aggravate HF Physical activity Stable patients only minutes, 3 5 times per week Smoking cessation (if applicable) Vaccinations Annual influenza Pneumococcal Restrict dietary sodium Restrict fluid (< 2L/day) Avoid salt substitutes (ex. Nu-salt, Also Salt)
41 41 Drugs that May Precipitate or Exacerbate Heart Failure Antiarrhythmic agents: except amiodarone (Cordarone, Pacerone) and dofetilide (Tikosyn) Calcium channel blockers: verapamil (Calan SR, Isoptin SR, Covera HS, Verelan), diltiazem (Cardizem) Beta blockers Nonsteroidal anti-inflammatory drugs Rosiglitazone (Avandia)/Pioglitazone (Actos) Glucocorticoids Androgens and estrogens Chemotherapeutic agents: doxorubicin, daumomycin, cyclophosphamide Amphetamines
42 Treatment of Stage A HF 42 Identify and modify risk factors HTN Dyslipidemia DM Smoking cessation Limit alcohol consumption and illicit drug use Consider ACEI or ARB for patients with multiple risk factors
43 Treatment of Stage B HF 43 Therapy from stage A ACEI and BB for: Recent MI Reduced EF ARB (if intolerant to ACEI)
44 Treatment of Stage C HFrEF 44 Therapy for stage A and B Diuretics and salt restriction (if fluid retention) ACEI BB ARB (if intolerant to ACEI) Avoid drugs known to exacerbate HF Consider aldosterone antagonist, digoxin, and/or hydralazine/isosrbide dinitrate combination
45 Loop Diuretics 45 Furosemide (Lasix) Bumetanide (Bumex) Torsemide (Demadex) Usual daily dose mg mg mg Ceiling dose 160 mg 2 mg 40 mg Bioavailability % 80-90% % Duration of effect 6 8 hrs 4 6 hrs hrs Indicated for control of fluid overload Initiate at low dose Target weight decrease of 0.5 to 1 kg/day (until symptoms resolve) The appropriate chronic dose is that which maintains the patient at a stable dry weight without symptoms of dyspnea
46 Beta-Blockers 46 Recommended for all stable patients with no or minimal signs of fluid overload and reduced LVEF Benefits: Decrease mortality and slow disease progression Decrease hospitalizations Improvement in functional class May lead to symptomatic worsening or decompensation Use in combination with diuretics and ACEI
47 Beta-Blockers 47 Drug Initial Dose Target Dose Bisoprolol* 1.25mg daily 10mg daily Carvedilol 3.125mg BID mg BID Carvedilol CR 10mg daily 80mg daily Metoprolol succinate CR/XL mg daily 200 mg daily Initiate low, double the dose every 2 weeks or as tolerated Patient should be clinically stable and euvolemic at time of initiation May take 2-3 months to see improvement in clinical response * Not FDA approved
48 Aldosterone Antagonist 48 Agents Spironolactone (Aldactone): mg daily Eplerenone (Inspra): 25-50mg daily Recommended for patients with NYHA Class III IV and LVEF < 35% or NYHA Class II + LVEF < 35% + history of CV hospitalization or elevated natriuretic peptide Adverse effects: hyperkalemia, gynecomastia Avoid concomitant use of NSAIDs, COX-2 inhibitors, high doses of ACEI or ARBs, potassium supplements, strong CYP3A4 inhibitors (eplerenone) DO NOT initiate if: GFR < 30 ml/min or SCr > 2.0 mg/dl in women or SCr> 2.5 mg/dl in men Potassium > 5 meq/l Triple therapy with ACEI + ARB + spironolactone is NOT routinely recommended
49 Isosorbide Dinitrate/Hydralazine 49 Shown to decrease mortality, hospitalization for HF, and quality of life in patients with symptomatic HF and decreased EF Should be considered: As an alternative to ACEI In addition to standard therapy in African American patients with symptomatic HF Dose: Hydralazine mg QID + Isosorbide dinitrate 20 40mg QID Bidil (isosorbide dinitrate 20mg/Hydralazine 37.5mg): 1-2 tablets TID Adverse effects: Common: headache, dizziness, nausea, hypotension Severe: leukopenia, hepatotoxicity, lupus
50 Digoxin 50 Consider adding if: Stage C or D + reduced EF + persistent symptoms of HF despite therapy with ACEI, BB, and diuretic Chronic atrial fibrillation Dosing considerations Decrease dose in elderly and patients with decreased renal function Target serum concentrations ng/ml Adverse effects: GI complaints Visual disturbances Cardiac arrhythmias
51 Treatment of Stage C HFpEF 51 Control underlying etiology of HF Use diuretics for pulmonary congestion and peripheral edema May use BB, ACEI, ARBs, or CCB to control symptoms Role for digoxin is not well established Aldosterone antagonists have not been studied in these patients Fluid and sodium restriction
52 Treatment of Stage D HF 52 Control fluid retention Fluid restriction Loop diuretic +/- thiazide like diuretic IV inotropic agents Non-pharmacologic measures Consider end-of life care Cardiac transplant Left-ventricular assist devices Intra-aortic balloon pump
53 Overview of Stages, Phenotypes and Treatment of HF At Risk for Heart Failure Heart Failure STAGE A At high risk for HF but without structural heart disease or symptoms of HF STAGE B Structural heart disease but without signs or symptoms of HF STAGE C Structural heart disease with prior or current symptoms of HF STAGE D Refractory HF e.g., Patients with: HTN Atherosclerotic disease DM Obesity Metabolic syndrome or Patients Using cardiotoxins With family history of cardiomyopathy Structural heart disease e.g., Patients with: Previous MI LV remodeling including LVH and low EF Asymptomatic valvular disease Development of symptoms of HF e.g., Patients with: Known structural heart disease and HF signs and symptoms Refractory symptoms of HF at rest, despite GDMT e.g., Patients with: Marked HF symptoms at rest Recurrent hospitalizations despite GDMT HFpEF HFrEF THERAPY Goals Heart healthy lifestyle Prevent vascular, coronary disease Prevent LV structural abnormalities Drugs ACEI or ARB in appropriate patients for vascular disease or DM Statins as appropriate THERAPY Goals Prevent HF symptoms Prevent further cardiac remodeling Drugs ACEI or ARB as appropriate Beta blockers as appropriate In selected patients ICD Revascularization or valvular surgery as appropriate THERAPY Goals Control symptoms Improve HRQOL Prevent hospitalization Prevent mortality Strategies Identification of comorbidities Treatment Diuresis to relieve symptoms of congestion Follow guideline driven indications for comorbidities, e.g., HTN, AF, CAD, DM Revascularization or valvular surgery as appropriate THERAPY Goals Control symptoms Patient education Prevent hospitalization Prevent mortality Drugs for routine use Diuretics for fluid retention ACEI or ARB Beta blockers Aldosterone antagonists Drugs for use in selected patients Hydralazine/isosorbide dinitrate ACEI and ARB Digoxin In selected patients CRT ICD Revascularization or valvular surgery as appropriate THERAPY Goals Control symptoms Improve HRQOL Reduce hospital readmissions Establish patient s endof-life goals Options Advanced care measures Heart transplant Chronic inotropes Temporary or permanent MCS Experimental surgery or drugs Palliative care and hospice ICD deactivation
54 Patient Education Symptom management Daily weight Sodium restriction Medication adherence Physical activity Modification of risk factors Follow-up appointments
55 Patient Case (Continued) 55 Three months later BE presents to your pharmacy with the following prescriptions from Dr. Wonder: Diovan 160mg, take 1 tablet PO daily, #30 Spironolactone 25mg, take 1 tablet PO daily, #30
56 Patient Profile 56 Patient Name: BE Address: 75 Dekalb Ave, Brooklyn, NY Age: 62 Height: 5 8 Weight: 251 lb Sex: F Phone: (800) Medication Profile Rx No. Physician Drug/Strength Qty Sig Refills Davis Atorvastatin 80mg 30 1 daily Davis Carvedilol 25mg 60 1 bid Davis Furosemide 40mg 30 1 daily Davis Fosinopril 40mg 30 1 daily Wonder Glipizide XL 10mg 30 1 daily George Tramadol 50mg 60 1 bid Davis Carvedilol 12.5mg 60 1 bid Davis Furosemide 40mg 60 1 daily Davis Fosinopril 40mg 30 1 daily Wonder Glipizide XL 10mg 30 1 daily George Tramadol 50mg 60 1 bid 2
57 Patient Case What concerns, if any, do you have regarding the new prescriptions for this patient? Provide patient education with regard to heart failure and drug therapy for this patient
58 Key Points: Heart Failure 58 Avoid factors known to exacerbate chronic HF Most patients with heart failure should be treated with an ACEI, BB, diuretic In patients with reduced EF and symptomatic HF despite standard therapy, consider: Isosorbide dinitrate/hydralazine (especially in African Americans) Aldosterone antagonist Digoxin ARBs For patients with preserved EF may use diuretics, BB, ACEI, ARBs, or CCBs Combine pharmacologic + non-pharmacologic therapy 58
59 Atrial Fibrillation Guidelines Update
60 What s new? Emphasis on shared decision making and individualization of therapy Increased emphasis on non-pharmacologic care Encourage the use of CHA 2 DS 2 -VASc vs. CHADS 2 score in stroke risk assessment Recommendations for use of dabigatran, rivaroxaban, and apixaban added Diminished role for aspirin use
61 Treatment Goals 61 Relieve symptoms Prevent thromboembolic complications Control ventricular rate Target resting HR < 80bpm May target resting HR < 110bmp if patient remains asymptomatic Restore and/or maintain normal sinus rhythm (NSR)
62 Stroke Prevention in Atrial Fibrillation 62 Patients with AF are at risk of cardioembolic stroke Risk of stroke increases with age and in presence of additional risk factors Consider antithrombotic therapy regardless of whether or not sinus rhythm is maintained Risk of thromboembolism AF > 48 hours = 15% rate of atrial thrombus AF > 72 hours = 30 % rate of atrial thrombus Thrombi present + cardioversion = 91% stroke rate Need for long-term antithrombotic therapy depends on assessment of risk of stroke
63 CHA 2 DS 2 - VASc Score Cardiac failure Hypertension A 2 ge (>75 years) Diabetes S 2 :stroke Vascular disease* Age Sex category: female CHA 2 DS 2 VA Sc Score Stroke Rate % 2 2.2% 3 3.2% 4 4% 5 6.7% 6 9.8% *Vascular disease = CAD, myocardial infarction, peripherl artery disease, complex aortic plaque Lip GY, et. al. Chest 2010;137(2):
64 Stroke Prevention: Summary 64 Stroke Risk Category Low (CHA 2 DS 2 -VASc score= 0) Intermediate (CHA 2 DS 2 -VASc score= 1) High (CHA 2 DS 2 -VASc score > 2) Recommended Therapy No therapy Aspirin mg daily or warfarin (target INR 2-3) 1 st line: anticoagulant 2 nd line: aspirin + clopidogrel Stroke.ahajournals.org/content/early/2012/08/02SRT.0b
65 Comparison of Oral Anticoagulants 65 Warfarin (Coumadin) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Apixaban (Eliquis) MOA VKA DTI FXa inhibitor FXa inhibitor Dose Variable 150mg BID 20mg QD WF 5mg BID P-gp substrate No Yes Yes Yes Hepatic elimination Dosage adjust in renal insuf? CYP2C9 (major), CYP3A4, CYP2C19,ot hers Glucuronidation CYP3A4 CYP3A4 No Yes Yes Yes Half-life hrs hrs 5-9 hrs ~ 12 hrs
66 Comparison of Oral Anticoagulants 66 DDI Adverse effects Warfarin CYP2C9 and 3A4 inhibitors; antibiotics; vitamin K Bleeding, alopecia, skin necrosis, purple toe syndrome Dabigatran (Pradaxa) P-gp inducers and inhibitors; PPIs, H2 blockers Bleeding Dyspepsia Rivaroxaban (Xarelto) CYP3A4 and/or P-gp inhibitors Bleeding Apixaban (Eliquis) CYP3A4 and/or P-gp inhibitors Bleeding Monitoring INR Antidote Vitamin K
67 Patient Education: Anticoagulants Warfarin Take warfarin at the same time each day Avoid drugs or alcohol that can interact with warfarin Keep a diet containing vitamin K consistent Dabigatran Swallow capsules whole. DO NOT break, chew, or empty pellets from the capsule Dispense in the original container. Once open, use within 4 months May cause indigestion, stomach upset Do not take newer agent with grapefruit or grapefruit juice Do not D/C abruptly Notify a healthcare provider if any signs of bleeding, clotting, or stroke occur and of any upcoming surgery or procedure
68 Rate Control: Decision Algorithm 68 Paroxysmal or permanent A. Fib No HF, LVEF > 40% LVEF < 40% B-Blocker, CCB B-blocker, digoxin, amiodarone Assess HR control HR > 110 bpm: increase dose of initial drug or add second drug
69 69 Choosing an Anti-arrhythmic Agent to Maintain Sinus Rhythm Maintenance of sinus rhythm No Stuctural heart disease Coronary artery disease Heart Failure LVH Dronedarone* Flecainide Propafenone Sotalol Dofetilide Amiodarone Dofetilide Dronedarone* Sotalol Amiodarone NYHA Class III/IV Amiodarone Dofetilide *paroxysmal or persistent AF only
70 Safety Considerations in Maintenance of Sinus Rhythm Drug Caution/Exclude Pharmacokinetics Flecainide HF, CAD Metabolized by CYP2D6 Renally excreted Propafenone HF, CAD, liver disease, asthma Metabolized by CYP2D6 Inhibits P-glycoprotein and CYP2C9
71 Safety Considerations in Maintenance of Sinus Rhythm Drug Caution/Exclude Pharmacokinetics Amiodarone Lung disease, may prolong QT Inhibits many CYP enzymes and P-glycoprotein Dofetilide Dronedarone Sotalol Prolonged QT, renal disease, hypokalemia, diuretic therapy Bradycardia, HF, liver disease, may prolong QT Prolonged QT, renal disease, hypokalemia, diuretic therapy, HF Metabolized by CYP3A4 DDI with inhibitors of tubular secretion Metabolized by CYP3A4 Inhibits CYP3A4, CYP2D6, P-glycoprotein
72 Patient Case Three months later BE is diagnosed with atrial fibrillation. PMHx: DM x 20 years; CAD x 15 years (MI in 1999 and 2001), heart failure, and osteoarthritis Medications: spironolactone, atorvastatin, valsartan, carvedilol, tramadol, furosemide, and glipizide BP = 134/78 mmhg, HR = 78 bpm
73 Patient Case What is DA s CHA 2 DS 2 VASc Score? Recommend an antithrombotic agent for this patient to prevent thromboembolic complications. Provide patient education with regard to antithrombotic therapy for this patient
74 CHA 2 DS 2 - VASc Score Cardiac failure Hypertension A 2 ge (>75 years) Diabetes S 2 :stroke Vascular disease* Age Sex category: female CHA 2 DS 2 VA Sc Score Stroke Rate % 2 2.2% 3 3.2% 4 4% 5 6.7% 6 9.8% *Vascular disease = CAD, myocardial infarction, peripherl artery disease, complex aortic plaque Lip GY, et. al. Chest 2010;137(2):
75 Summary 75 Treatment options to control rate are BB, CCB, digoxin, and amiodarone All patients need to be evaluated for risk of stroke. Most patients require therapy for stroke prevention Rhythm control is indicated in select patients to help control symptoms Amiodarone and dofetilide are preferred for patients with structural heart disease
76 Thank you!
DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More information1/4/18. Heart Failure Guideline Review and Update. Disclosure. Pharmacist Objectives. Pharmacy Technician Objectives. What is Heart Failure?
Disclosure Heart Failure Guideline Review and Update I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation. Natalie Beiter,
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 informationHeart Failure Clinician Guide JANUARY 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.
More informationCase 1. Case 2. What do you think about reducing or discontinuing some of the above now that his LVEF has normalized?
Case 1 A primary care colleague inquires what to do with a patient (HFrEF in NSR) who has a digoxin level of 2.8ng/ml. Level was obtained at 10am, patient takes all medications at one time upon arising
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 informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
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 informationCardiovascular Clinical Practice Guideline Pilot Implementation
Cardiovascular Clinical Practice Guideline Pilot Implementation Pharmacologic Management of Chronic Heart Failure Sept 15, 2004 Angela Allerman, PharmD, BCPS DoD Pharmacoeconomic Center Promoting high
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 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 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 informationContemporary Management of Heart Failure. Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium
Contemporary Management of Heart Failure Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium Disclosures I have no relevant relationships with commercial
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 informationConflict of Interest Disclosure. Learning Objectives. Learning Objectives. Guidelines. Update on Lifestyle Guidelines
Conflict of Interest Disclosure Updates for the Ambulatory Care Pharmacist: Dyslipidemia and CV Risk Assessment No conflicts of interest to disclose 2014 Updates to the Updates in Ambulatory Care Pharmacy
More informationChronic. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Michael G. Shlipak, MD, MPH
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationAtrial Fibrillation and the NOAC s. John Raymond MS, PA-C, MHP February 10, 2018
Atrial Fibrillation and the NOAC s John Raymond MS, PA-C, MHP February 10, 2018 Pathogenesis EPIDEMIOLOGY Arrhythmia-related hospitalisations in the US Ventricular fibrillation 2% Atrial fibrillation 34%
More informationNew PINNACLE Measures The below measures for PINNACLE will be added as new measures to the outcomes reporting starting with Version 2.0.
New PINNACLE Measures The below measures for PINNACLE will be added as new measures to the outcomes reporting starting with Version 2.0. Measure Steward Measure Name Measure Description Rationale for Adding
More informationCardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
More informationCost and Prevalence of A fib. Atrial Fibrillation: Guideline Directed Treatment. Prevalence of A Fib. Risk Factors for A Fib. Risk Factors for A Fib
Atrial Fibrillation: Guideline Directed Treatment Melissa Wendell, FNP-C, MSN Heart Failure - Lead Nurse Practitioner, Aspirus Wausau Hospital and Aspirus Cardiology Cost and Prevalence of A fib 33.5 million
More informationHypertension (JNC-8)
Hypertension (JNC-8) Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! The 8 th Joint
More informationEvaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF<40%
Evaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF
More informationPerformance and Quality Measures 1. NQF Measure Number. Coronary Artery Disease Measure Set
Unless indicated, the PINNACLE Registry measures are endorsed by the American College of Cardiology Foundation and the American Heart Association and may be used for purposes of health care insurance payer
More informationOptimizing CHF Therapy: The Role of Digoxin, Diuretics, and Aldosterone Antagonists
Optimizing CHF Therapy: The Role of Digoxin, Diuretics, and Aldosterone Antagonists Old Drugs for an Old Problem Jay Geoghagan, MD, FACC BHHI Primary Care Symposium February 28, 2014 None. Financial disclosures
More informationLong-Term Care Updates
Long-Term Care Updates July 2015 By Amy Friedman Wilson, PharmD Heart failure (HF) is a clinical condition in which ventricular filling or ejection of blood is structurally or functionally impaired. 1
More informationHypertension Update. Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy
Hypertension Update Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy Introduction 1/3 of US adults have HTN More prevalent in non-hispanic
More informationGuideline-Directed Medical Therapy
Guideline-Directed Medical Therapy Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation OPTIMAL THERAPY (As defined in
More informationTopic: Chronic Heart Failure Cases for Monday s March 21th lecture.
1 Phar6122: CV section Date: 3/21/05 Topic: Chronic Heart Failure Cases for Monday s March 21th lecture. Directions: This handout includes three chronic heart failure cases of increasing difficulty. In
More informationDysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics
Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise
More informationHeart Failure Management Policy and Procedure Phase 1
1301 Punchbowl Street, Harkness Suite 225 Honolulu, Hawaii 96813 Phone (808) 691-7220 Fax: (808) 691-4099 www.queenscipn.org Policy and Procedure Phase 1 Policy Number: Effective Date: Revised: Approved
More informationCLINICAL PRACTICE GUIDELINE
CLINICAL PRACTICE GUIDELINE Procedure: Congestive Heart Failure Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014
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 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 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 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 informationUnderstanding Atrial Fibrillation Management. Roy Lin, MD
Understanding Atrial Fibrillation Management Roy Lin, MD Disclosure None Definition of atrial fibrillation Atrial fibrillation is a supraventricular tachyarrhythmia characterized by uncoordinated atrial
More informationEstimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches
Heart Failure: Management of a Chronic Disease Jenny Bauerly RN, CHFN, APRN-BC Heart Failure (HF) Definition A complex clinical syndrome that can result from any structural or functional cardiac disorder
More informationWhat s New in the AF Guidelines
Impact on New AF Guidelines on Heart Failure Management Gothenburg - May 22 nd 2011 Europace (2010) 12, 1360-420 http://europace.oxfordjournals.org JACC (2011) 57, 223-42 http://www.cardiosource.org What
More informationThe ACC Heart Failure Guidelines
The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA
More informationHeart Failure. Dr. William Vosik. January, 2012
Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment
More informationAtrial Fibrillation and Heart Failure: A Cause or a Consequence
Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November
More informationAntialdosterone treatment in heart failure
Update on the Treatment of Chronic Heart Failure 2012 Antialdosterone treatment in heart failure 전남의대윤현주 Chronic Heart Failure Prognosis of Heart failure Cecil, Text book of Internal Medicine, 22 th edition
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationHeart Failure CTSHP Fall Seminar
Heart Failure CTSHP Fall Seminar Laurajo Ryan, PharmD, MSc, BCPS, CDE Pharmacist Learning Objectives Outline the pathophysiology of heart failure List triggers for decompensated heart failure Describe
More informationNew Advances in the Diagnosis and Management of Acute and Chronic Heart Failure
New Advances in the Diagnosis and Management of Acute and Chronic Heart Failure Deborah Budge, MD Intermountain Healthcare Heart Failure Cardiologist Objectives: State the updates from the ACC 2013 HF
More informationControversies in Atrial Fibrillation and HF
Controversies in Atrial Fibrillation and HF Dr.Yahya Al Hebaishi Cardiac electrophysiology division, PSCC, Riyadh Atrial Fibrillation: Rate or Rhythm? HF and AF: the twin epidemic of cardiovascular disease.
More information7/7/ CHD/MI LVH and LV dysfunction Dysrrhythmias Stroke PVD Renal insufficiency and failure Retinopathy. Normal <120 Prehypertension
Prevalence of Hypertension Hypertension: Diagnosis and Management T. Villela, M.D. Program Director University of California, San Francisco-San Francisco General Hospital Family and Community Medicine
More informationHEART FAILURE KEEPING YOUR PATIENT AT HOME
HEART FAILURE KEEPING YOUR PATIENT AT HOME SUZANNE FRAZIER MS, CRNP, NP-C, CHFN HEART FAILURE DISEASE MANAGEMENT COORDINATOR PENN STATE HERSHEY HEART & VASCULAR INSTITUTE IMPACT OF HEART FAILURE In 2010,
More informationUpdates in Cardiovascular Recommendations for Diabetic Patients
Updates in Cardiovascular Recommendations for Diabetic Patients Chris Tawwater, Pharm.D., BCPS Clinical Pharmacist, Abilene Regional Medical Center Assistant Professor, Adult Medicine Division Pharmacotherapy
More informationHypertension diagnosis (see detail document) Diabetic. Target less than 130/80mmHg
Hypertension diagnosis (see detail document) Non-diabetic Diabetic Very elderly (older than 80 years) Target less than 140/90mmHg Target less than 130/80mmHg Consider SBP target less than 150mmHg Non-diabetic
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More information2013 ACC/AHA Cholesterol Guidelines JULIE HAMMOND, D.O. PGY-2 MATTHEW PAOLI, D.O. PGY-2
2013 ACC/AHA Cholesterol Guidelines JULIE HAMMOND, D.O. PGY-2 MATTHEW PAOLI, D.O. PGY-2 GOALS ACC/AHA as publisher of guidelines Determining which patients are appropriate for statin therapy The treatment
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 informationARNI (Angiotensin Receptor blocker / Neprilysin Inhibitors [Sacubutril/Valsartan]) Heart Failure Medication Initiation and Titration
ARNI (Angiotensin Receptor blocker / Neprilysin Inhibitors [Sacubutril/Valsartan]) Heart Failure Medication and Symptomatic HF despite ACEI/ARB and B-blocker therapy Bilateral renal artery stenosis Moderate/Severe
More informationLearning Objectives. Patient Case
Joseph Saseen, Pharm.D., FASHP, FCCP, BCPS Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Learning Objectives Identify the 4 patient populations
More informationHEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading
More informationAtrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted.
Patient Name: Diagnosis: Allergies with reaction type: Atrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted. Telemetry Medical Telemetry:
More informationHypertension and Atrial Fibrillation in 2017
Boma Inn, Eldoret, 24th 25thFebruary 2017 Hypertension and Atrial Fibrillation in 2017 Dr Mzee Ngunga Consultant Cardiologist Aga Khan University Hospital, Nairobi Objectives 1. Understand the relationship
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 informationMedications for Treating Stroke
Medications for Treating Stroke Subject Expert Sonny Kupniewski, PharmD, BCPS Swedish Medical Center Englewood, CO 2 Objectives Medications used to prevent stroke Prevention of strokes in patients with
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 informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
More informationIntroduction to Heart Failure. Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL
Introduction to Heart Failure Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL Disclosures No relevant financial relationships to disclose Objectives and Outline Define heart
More informationDisclosures. This speaker has indicated there are no relevant financial relationships to be disclosed.
Disclosures This speaker has indicated there are no relevant financial relationships to be disclosed. And the Beat Goes On: New Medications for Heart Failure Alison M. Walton, PharmD, BCPS The Case of
More informationCardiovascular Pharmacotherapy
Cardiovascular Pharmacotherapy Overview Mechanism of cardiovascular drugs Indications and clinical use in cardiology Renin-Angiotensin Inhibitors: Angiotensin-Converting Enzyme Inhibitors, Angiotensin
More informationHeart failure. Failure? blood supply insufficient for body needs. CHF = congestive heart failure. increased blood volume, interstitial fluid
Failure? blood supply insufficient for body needs CHF = congestive heart failure increased blood volume, interstitial fluid Underlying causes/risk factors Ischemic heart disease (CAD) 70% hypertension
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
PREVENTING CARDIOVASCULAR DISEASE IN WOMEN: Current Guidelines for Hypertension, Lipids and Aspirin Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
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 informationHighlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM OSHP 2014 Annual Meeting Oklahoma City, OK April 4, 2014 1 Objectives
More informationRate and Rhythm Control of Atrial Fibrillation
Rate and Rhythm Control of Atrial Fibrillation April 21, 2017 춘계심혈관통합학술대회 Jaemin Shim, MD, PhD Arrhythmia Center Korea University Anam Hospital Treatment of AF Goal Reducing symptoms Preventing complication
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 informationDisclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018
Disclosure Statement Heart Failure: Refreshers and Updates Tracy K. Pettinger, PharmD Clinical Associate Professor College of Pharmacy The planners and presenter of this presentation have disclosed no
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationLipids What s new? Meera Jain, MD Providence Portland Medical Center
Lipids 2016- What s new? Meera Jain, MD Providence Portland Medical Center 1 Can I trust the ASCVD risk calculator? Do harms outweigh benefits in primary prevention? Is there anything besides a statin?
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 informationCoronary Artery Disease Clinical Practice Guidelines
Coronary Artery Disease Clinical Practice Guidelines Guidelines are systematically developed statements to assist patients and providers in choosing appropriate healthcare for specific clinical conditions.
More informationI have no disclosures. Disclosures
I have no disclosures Disclosures What is Heart Failure? Heart Failure (HF) A complex clinical syndrome where patients present with symptoms (i.e. dyspnea, fatigue, fluid retention) that result from any
More informationVA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005
VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005 1 Any adult in the health care system 2 Obtain blood pressure (BP) (Reliable,
More informationCurrent Guideline for AF Treatment. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine
Current Guideline for AF Treatment Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Case 1 59 year-old lady Sudden palpitation and breathlessness for 12 hours
More informationPIEDMONT ACCESS TO HEALTH SERVICES, INC. Guidelines for Screening and Management of Dyslipidemia
PIEDMONT ACCESS TO HEALTH SERVICES, INC. Policy Number: 01-09-021 SUBJECT: Guidelines for Screening and Management of Dyslipidemia EFFECTIVE DATE: 04/2008 REVIEWED/REVISED: 04/12/10, 03/17/2011, 4/10/2012,
More informationHeart Failure Update John Coyle, M.D.
Heart Failure Update 2011 John Coyle, M.D. Causes of Heart Failure Anderson,B.Am Heart J 1993;126:632-40 It It is now well-established that at least one-half of the patients presenting with symptoms and
More informationHeFSSA Practitioners Program 2017 Theme The Patient Journey: Feel Good and Live Long. Case Study 2
HeFSSA Practitioners Program 2017 Theme The Patient Journey: Feel Good and Live Long Case Study 2 HEART FAILURE WITH MID-RANGE EJECTION FRACTION TREATMENT OPTIONS CLINICAL CASE MEDICAL HISTORY 59-year-old
More informationAntihypertensive drugs SUMMARY Made by: Lama Shatat
Antihypertensive drugs SUMMARY Made by: Lama Shatat Diuretic Thiazide diuretics The loop diuretics Potassium-sparing Diuretics *Hydrochlorothiazide *Chlorthalidone *Furosemide *Torsemide *Bumetanide Aldosterone
More informationHypertension: JNC-7. Southern California University of Health Sciences Physician Assistant Program
Hypertension: JNC-7 Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! Reference Card
More informationBasics of Atrial Fibrillation. By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY
Basics of Atrial Fibrillation By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY Atrial Fibrillation(AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation
More informationManagement Strategies for Advanced Heart Failure
Management Strategies for Advanced Heart Failure Mary Norine Walsh, MD, FACC Medical Director, HF and Cardiac Transplantation St Vincent Heart Indianapolis, IN USA President American College of Cardiology
More informationHow to Handle Statin Intolerance in the High Risk Patient
How to Handle Statin Intolerance in the High Risk Patient Thomas D. Conley, MD FACC FSCAI Disclosures: None 1 Definition of High Risk Primary Prevention ASCVD Risk Calculator Adults >21 yrs, LDL 190 mg/dl
More informationDyslipidemia in the light of Current Guidelines - Do we change our Practice?
Dyslipidemia in the light of Current Guidelines - Do we change our Practice? Dato Dr. David Chew Soon Ping Senior Consultant Cardiologist Institut Jantung Negara Atherosclerotic Cardiovascular Disease
More informationCholesterol Management Roy Gandolfi, MD
Cholesterol Management 2017 Roy Gandolfi, MD Goals Interpreting cholesterol guidelines Cholesterol treatment in diabetics Statin use and side effects therapy Reporting- Comparison data among physicians
More informationClinical Practice Guideline
Clinical Practice Guideline Secondary Prevention for Patients with Coronary and Other Vascular Disease Since the 2001 update of the American Heart Association (AHA)/American College of Cardiology (ACC)
More informationHFpEF. April 26, 2018
HFpEF April 26, 2018 (J Am Coll Cardiol 2017;70:2476 86) HFpEF 50% or more (40-71%) of patients with CHF have preserved LV systolic function. HFpEF is an increasingly frequent hospital discharge. Outcomes
More informationATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships
More informationCARDIAC REHABILITATION PROGRAMME:- MEDICATION
CARDIAC REHABILITATION PROGRAMME:- MEDICATION AIM OF THIS SESSION Understand the reasons for taking your medications, Discuss the common side effects associated with these medications - knowing when to
More informationHypertensionTreatment Guidelines. Michaelene Urban APRN, MSN, ACNS-BC, ANP-BC
HypertensionTreatment Guidelines Michaelene Urban APRN, MSN, ACNS-BC, ANP-BC Objectives: Review the definition of the different stages of HTN. Review the current guidelines for treatment of HTN. Provided
More informationHalf Moon Bay Treatment of Atrial Fibrillation. Dr. Roger A. Winkle MD. Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital
Half Moon Bay 2018 Treatment of Atrial Fibrillation Dr. Roger A. Winkle MD Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital Disclosures: Investor Farapulse Things a Primary Care Doctor Should
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationHEART FAILURE PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
HEART FAILURE PHARMACOLOGY University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 LEARNING OBJECTIVES Understand the effects of heart failure in the body
More informationProgram Metrics. New Unique ID. Old Unique ID. Metric Set Metric Name Description. Old Metric Name
Program Metrics The list below includes the metrics that will be calculated by the PINNACLE Registry for the outpatient office setting. These include metrics for, Atrial Fibrillation, Hypertension and.
More informationObjectives. Heart failure and Hypertension. Definition & epidemiology of heart failure HEART FAILURE 3/12/2016. Kirsten Bibbins-Domingo, PhD, MD, MAS
Objectives Heart failure and Hypertension Kirsten Bibbins-Domingo, PhD, MD, MAS Lee Goldman, MD Endowed Chair in Medicine Professor of Medicine and of Epidemiology and Biostatistics University of California,
More information