Pravin Manga Division of Cardiology Department of Medicine University of Witwatersrand
|
|
- Harold Johns
- 5 years ago
- Views:
Transcription
1 Pravin Manga Division of Cardiology Department of Medicine University of Witwatersrand
2 Overview Definition Epidemiology Biomarkers Treatment
3 Clinical Heart Failure: Syndrome in which patients have typical symptoms (breathlessness, ankle swelling and fatigue) and signs (elevated JVP, crepitations) resulting from an abnormality of cardiac structure and function Definition
4 Definition Heart Failure: Heart Failure Reduced EF : HF-REF EF 35% Grey Area EF 35-50% Heart Failure Preserved EF : HF-PEF EF 50% ESC guideline 2012
5 Definition Heart Failure: Heart Failure Reduced EF : HF-REF EF 35% Grey Area EF 35-50% Heart Failure Preserved EF : HF-PEF EF 50% ESC guideline 2012
6 Definition Heart Failure: Heart Failure Reduced EF : HF-REF EF 50% Heart Failure Preserved EF : HF-PEF EF 50% HeFSSA perspective on ESC guideline SAMJ 2013;103:
7 Definition Clinical Heart Failure: Acute Chronic ESC guideline 2012
8 Discharges in thousands Heart failure is a major and growing public health problem Improvements in survival following MI, an aging population and increasing prevalence of risk factors such as hypertension may all contribute to an increasing prevalence of HF 1, Male Female Years Hospital discharges for HF by sex (USA: ). 3 HF=heart failure; MI=myocardial infarction 1. Hunt et al. J Am Coll Cardiol 2009;53:e1 90; 2. Dickstein et al. Eur Heart J 2008;29: ; 3. Lloyd-Jones et al. Circulation 2010;121:e46 e215
9 Epidemiology Burden of HF doubles with every decade after age 40 Ageing population Burden of risk factors: Hypertension Diabetes IHD Obesity Rheumatic heart disease HIV
10 Patients have a poor prognosis following heart failure hospitalization
11 Cumulative probability of survival Cumulative probability of survival Outcomes for heart failure patients are poor in clinical practice HF mortality is high, with 50% of patients dying within 4 years of diagnosis and 40% of hospitalized patients dead or readmitted within 1 year Female survival rates (%): Male survival rates (%): HF, MI and other malignancies 2 HF, MI and other malignancies Breast MI MI Bladder Bowel Ovarian HF Prostate Bowel HF Lung Lung Month of follow-up Month of follow-up All patients with a first admission to any Scottish hospital in 1991 for HF, MI or the four most common types of cancer specific to men and women were identified, and 5-year survival rates compared 2 1. Dickstein et al. Eur Heart J 2008;29: ; 2. Stewart et al. Eur J Heart Fail 2001;3:315 22
12 Acute HF definition Acute HF is defined as rapid onset or change in the signs and symptoms of HF, resulting in the need for urgent therapy (ESC 1 ) development of acute or progressive symptoms of HF resulting in the need for hospitalization of the patient (ACC/AHA 2 ) 1 ESC Guidelines. Dickstein K, et al. Eur Heart J 2008;29: ; 2 ACC/AHA Guidelines. Hunt SA, et al. J Am Coll Cardiol 2009;53:e1 90
13 AHF Physiopathology AHF is characterized by severe haemodynamic and neurohormonal abnormalities that may cause myocardial injury and/or renal dysfunction or may be a result of it AHF: Neurohormonal storm RASS activation Cytokine system activation Sympathetic hyperactivation
14 Overview Definition Epidemiology Biomarkers Treatment
15 pro-bnp (aa1-aa108) Cleavage NT-pro BNP (aa1-aa76) BNP (aa77-aa108)
16 Role of Biomarkers Where echocardiography is limited an alternative approach to diagnosis of HF is to measure BNP BNP < 100pg/ml or NT ProBNP <300 pg/ml in acute presentation excludes diagnosis of HF-REF ESC guideline 2012
17 Hazard ratio (95% confidence interval [CI]) BNP and NT-proBNP are markers of prognosis in chronic HF Increased levels of B-type natriuretic peptide (BNP) and N-terminal probnp (NTproBNP) are linked to worse outcomes in chronic HF 8 Mortality and morbidity BNP NT-proBNP (lowest) Deciles (highest) Masson et al. Clin Chem 2006;52:
18 Change in BNP levels linked with change in mortality in HF patients BNP (pg/ml) 300 n= High high Mortality (%) 25.4% n=462 Low high n=229 High low n=1679 Low low 0 4 months 22.7% 12.8% 7.9% Latini R, et al. Am J Med 2006;119:70.e23-30
19 Overview Definition Epidemiology Biomarkers Treatment
20 Treatment goals in acute HF Current guidelines split treatment goals into: Immediate Relieve symptoms and stabilize the haemodynamic condition Intermediate Initiate pharmacological therapy and minimize length of hospitalization Long-term Prevent early re-hospitalization Improve Q of L
21 Current treatment of acute heart failure Treatment goals are to relieve dyspnoea and congestion Current standard of care is i.v. loop diuretics with or without nitrate vasodilators Current treatments do not have a strong evidence base Supporting evidence is derived from a single randomized clinical trials or from large non-randomized studies Dickstein et al. Eur Heart J 2008;29:
22 Dose Study Aimed to evaluate the safety and efficacy of various initial strategies of furosemide therapy in patients with ADHF Route of administration: Q12 hours bolus Continuous infusion Dosing Low intensification (1 x oral dose) High intensification (2.5 x oral dose)
23 Diuretic Strategies in Patients with Acute Decompensated Heart Failure G. Michael Felker, M.D., M.H.S., Kerry L. Lee, Ph.D., David A. Bull, M.D., Margaret M. Redfield, M.D., Lynne W. Stevenson, M.D., Steven R. Goldsmith, M.D., Martin M. LeWinter, M.D., Anita Deswal, M.D., M.P.H., Jean L. Rouleau, M.D., Elizabeth O. Ofili, M.D., M.P.H., Kevin J. Anstrom, Ph.D., Adrian F. Hernandez, M.D., Steven E. McNulty, M.S., Eric J. Velazquez, M.D., Abdallah G. Kfoury, M.D., Horng H. Chen, M.B., B.Ch., Michael M. Givertz, M.D., Marc J. Semigran, M.D., Bradley A. Bart, M.D., Alice M. Mascette, M.D., Eugene Braunwald, M.D., and Christopher M. O'Connor, M.D. for the NHLBI Heart Failure Clinical Research Network N Engl J Med 2011; 364:
24 Change in Creatinine (mg/dl) Change in Creatinine at 72 hours p = 0.45 p = Q12 Continuous Low High
25 Proportion with Death, Rehosp, or ED Visit Proportion with Death, Rehosp, or ED visit Death, Rehospitalization, or ED Visit 0.6 HR for Continuous vs. Q12 = % CI 0.86, 1.66, p = HR for High vs. Low = % CI 0.60, 1.16, p = Continuous Q High Low Days Days
26 Cardiac and/or Renal Function AHF and Progression of HF Hospitalization Hypothesis: With each hospitalization, there is myocardial and or renal damage Hospitalization Hospitalization Gheorghiade M et al. Am J Cardiol. 2005; 96 (6A) Time
27 Cardiac and/or Renal Function AHF and Progression of HF Identify triggers to decompensation Optimizing medical therapy Hospitalization Hospitalization Hospitalization Gheorghiade M et al. Am J Cardiol. 2005; 96 (6A) Time
28 Newer Therapies Levosimendan Nesiritide Rolofyline Serelaxin Renin inhibition (aliskiren) is it an effective and safe alternative to/addition to ACE inhibition? Dual neprilysin/angiotensin receptor inhibitors efficacy and safety compared with an ACE inhibitor?
29 RELAXIN: A New Treatment for AHF
30 Relaxin Relaxin Peptide hormone Similar in size and shape to insulin (MW 5963) Found in men and women Normal hormone of pregnancy Benign safety profile
31 RELAX-AHF The Lancet, 2013; 381:29-39
32 RELAX-AHF The Lancet, 2013; 381:29-39
33 RELAX-II Can Seralaxin show mortality benefit in a large randomized phase 3 trial? The Lancet, 2013; 381:29-39
34 Definition Clinical Heart Failure: Acute Chronic
35 Guidelines recommend several core therapies for patients with chronic HF Therapy ACEIs Recommendation Recommended for patients with LVEF 40% to reduce risk of mortality and HF hospitalization (unless contraindicated or not tolerated) Class effect
36 Guidelines recommend several core therapies for patients with chronic HF Therapy ACEIs Recommendation Recommended for patients with LVEF 40% to reduce risk of mortality and HF hospitalization (unless contraindicated or not tolerated) ARBs Recommended in patients with LVEF 40% unable to tolerate ACEI therapy to reduce risk of mortality and HF hospitalization 36
37 Guidelines recommend several core therapies for patients with chronic HF Therapy β-blockers Recommendation Recommended for patients with LVEF 40% to reduce risk of mortality and HF hospitalization 37 Presentation Title Presenter Name Date Subject Business Use Only
38 Guidelines recommend several core therapies for patients with chronic HF Therapy β-blockers Recommendation Recommended for patients with LVEF 40% to reduce risk of mortality and HF hospitalization Carvedilol Bisoprolol Metoprolol 38 Presentation Title Presenter Name Date Subject Business Use Only
39 Guidelines recommend several core therapies for patients with chronic HF Therapy Aldosterone antagonists Recommendation Recommended for patients with persisting symptoms (NYHA class II IV) and LVEF 35%, despite treatment with an ACEI (or ARB if an ACEI is not tolerated) and a β- blocker, to reduce risk of mortality and HF hospitalization
40 Guidelines recommend several core therapies for patients with chronic HF Therapy Aldosterone antagonists Recommendation Recommended for patients with persisting symptoms (NYHA class II IV) and LVEF 35%, despite treatment with an ACEI (or ARB if an ACEI is not tolerated) and a β- blocker, to reduce risk of mortality and HF hospitalization Spironolactone Epleranone
41
42
43
44
45
46
47
48
49 PARADIGM-HF Study design Randomization Double-blind period Single-blind run-in period LCZ mg BID Enalapril 10 mg BID 2 weeks LCZ mg BID LCZ mg BID 1 2 weeks 2 4 weeks 1:1 randomization Enalapril 10 mg BID Primary endpoint: CV death or hospitalization for HF Study designed as a CV mortality trial sample size was determined by effect on CV mortality, not the primary endpoint Entry criteria: NYHA class II IV HF LVEF 40%, lowered to 35% in a protocol amendment BNP 150 pg/ml (NT-proBNP 600 pg/ml), OR BNP 100 pg/ml (NT-proBNP 400 pg/ml) and a hospitalization for HF within the last 12 months Stable on an ACEI or an ARB at a dose equivalent to enalapril 10 mg/day + β-blocker ± aldosterone antagonist Systolic BP 95 mmhg, egfr 30 ml/min/1.73 m 2 and serum potassium 5.4 meq/l at randomization 49
50 Physiological response NP system RAAS Pathophysiological response NPs Ang II Inactive fragments Neprilysin inhibitor Inactive fragments AT 1 receptor Vasodilation Vasoconstriction BP Sympathetic tone Aldosterone Fibrosis Hypertrophy Natriuresis/diuresis HF symptoms/ progression BP Sympathetic tone Aldosterone Fibrosis Hypertrophy
51 LCZ696 Physiological response NP system RAAS Pathophysiological response NPs Ang II Inactive fragments Neprilysin inhibitor Inactive fragments Valsartan AT 1 receptor Vasodilation Vasoconstriction BP Sympathetic tone Aldosterone Fibrosis Hypertrophy Natriuresis/diuresis HF symptoms/ progression BP Sympathetic tone Aldosterone Fibrosis Hypertrophy
52 PARADIGM-HF Baseline characteristics and conclusions 8,442 patients recruited at 985 sites in 47 countries Conclusions: Trial stopped early (March 2014) by the Data Monitoring Committee due to a significant drop in CV mortality in addition to the primary endpoint 52
53 ? 8% 53
54 The End
Management of Advanced Systolic Heart Failure. Robert W. Hull MD FACC Associate Professor of Medicine West Virginia University
Management of Advanced Systolic Heart Failure Robert W. Hull MD FACC Associate Professor of Medicine West Virginia University American College of Cardiology Foundation (ACCF) American Heart Association
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 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 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 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 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 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 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 informationUPDATES IN MANAGEMENT OF HF
UPDATES IN MANAGEMENT OF HF Jennifer R Brown MD, MS Heart Failure Specialist Medstar Cardiology Associates DC ACP Meeting Fall 2017 Disclosures: speaker bureau for novartis speaker bureau for actelion
More 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 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 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 informationBehandeling van Hartfalen: over 5 jaar
Behandeling van Hartfalen: over 5 jaar Adriaan Voors, cardioloog UMCG Over 5 jaar Heart Failure Treatment in 5 Years HFrEF: best evidence, biggest pipeline Entresto Omcamtiv LVAD: destination therapy HFrEF:
More informationHeart Failure: 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 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 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 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 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 information2017 ACC/AHA/HFSA HF guidelines. Advances in the Use of Biomarkers in Heart Failure Patients. Outline
Advances in the Use of Biomarkers in Heart Failure Patients Lori B. Daniels, MD, MAS, FACC, FAHA Professor of Medicine Director, Cardiovascular Intensive Care Unit Sulpizio Cardiovascular Center UC San
More informationHow to define the target population?
Heart Failure 2011 22-24 May. Gothenburg, Sweden Mortality or morbidity as target in acute heart failure trials How to define the target population? Marco Metra, Brescia The Burden of Acute HF Acute HF
More informationHeFSSA Prac++oners Program 2016 What is NEW in Heart Failure treatment?
HeFSSA Prac++oners Program 2016 What is NEW in Heart Failure treatment? 08:00 Registra-on 08:25 Welcome and Thank You to Sponsors 08:30 09:15 10:00 10:30 The new kid on the block ARNI How do I effec-vely
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 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 informationThe NEW Heart Failure Guidelines
The NEW Heart Failure Guidelines Daily Practice HF scenario of the Case Presentations HF as a complex and heterogeneous syndrome Several proposed pathophysiological mechanisms involving the heart and the
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 informationACUTE HEART FAILURE. Julie Gorchynski MD, MSc, FACEP, FAAEM. Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014
ACUTE HEART FAILURE Julie Gorchynski MD, MSc, FACEP, FAAEM Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014 No disclosures Objectives Overview Cases Current Therapy
More informationHeart Failure: Combination Treatment Strategies
Heart Failure: Combination Treatment Strategies M. McDonald MD, FRCP State of the Heart Symposium May 28, 2011 None Disclosures Case 69 F, prior MIs (LV ejection fraction 25%), HTN No demonstrable ischemia
More informationAkash Ghai MD, FACC February 27, No Disclosures
Akash Ghai MD, FACC February 27, 2015 No Disclosures Epidemiology Lifetime risk is > 20% for American s older than 40 years old. > 650,000 new cases diagnosed each year. Incidence increases with age: 2%
More informationESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure
ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg
More 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 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 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 informationState of the Art: acute heart failure Is it just congestion?
ESC CONGRESS 2017 Barcelona, 26. 30. August 2017 State of the Art: acute heart failure Is it just congestion? S.B. Felix, FESC Klinik für Innere Medizin B Ernst-Moritz-Arndt-Universität Greifswald 1456
More 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 informationHeart Failure 2012: The Update WELCOME. Steven R. Goldsmith, M.D.
Heart Failure 2012: The Update WELCOME Steven R. Goldsmith, M.D. Professor of Medicine, University of Minnesota Director, Heart Failure Program, Hennepin County Medical Center Director, MN Heart Failure
More informationCardio-Renal Syndrome in Acute Heart Failure:
Cardio-Renal Syndrome in Acute Heart Failure: Target for Therapy Marvin A. Konstam, M.D. Research support and/or consulting relevant to this lecture: Merck, Otsuka, Johnson & Johnson; Amgen; Cardiokine
More informationHeart Failure with preserved ejection fraction (HFpEF)
Heart Failure with preserved ejection fraction (HFpEF) Dr. Pierpaolo Pellicori Hull York Medical School Kingston-upon-Hull United Kingdom Conflict of interest: none Heart failure is a contemporary problem
More informationHFpEF, Mito or Realidad?
HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY
More information8:30-10:30 WS #4: Cardiology :00-13:00 WS #11: Cardiology 101 (Repeated)
Professor Ralph Stewart Cardiologist Auckland City Hospital Green Lane Cardiovascular Research Unit Auckland Heart Group Fiona Stewart Cardiologist Green Lane Hospital National Women's Hospital Professor
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 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 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 informationKeynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes?
Keynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes? 24 th Annual San Diego Heart Failure Symposium June 1-2, 2018 La Jolla, CA Barry Greenberg, MD Distinguished Professor
More 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 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 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 informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients
More informationAcute heart failure syndromes: clinical challenges. Pathophysiology. ESC Congress August. Paris, France. Marco Metra
ESC Congress 2011 27-31 August. Paris, France. Acute heart failure syndromes: clinical challenges. Pathophysiology Marco Metra Cardiology, Dept. Of experimental and applied medicine. University of Brescia.
More 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 informationBeta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes Seung-Jae Joo and other KAMIR-NIH investigators Department of Cardiology, Jeju National
More informationHeart Failure and Renal Failure. Gerasimos Filippatos, MD, FESC, FHFA President HFA
Heart Failure and Renal Failure Gerasimos Filippatos, MD, FESC, FHFA President HFA Definition Epidemiology Pathophysiology Management (?) Recommendations for NHLBI in cardiorenal interactions related to
More 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 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 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 informationHFpEF 2016 : Comorbidities and Outcomes
HFpEF 2016 : Comorbidities and Outcomes Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine, Duke University Editor in Chief, JACC: Heart
More 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 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 John McMurray University of Glasgow.
A to Z of RAAS blockade in heart failure John McMurray BHF Cardiovascular Research Centre University of Glasgow. RAAS inhibition in CHF ACE inhibition in patients with low LVEF CHF CONSENSUS Enalapril
More information2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure Developed in Collaboration With the American Academy of Family Physicians, American College of Chest
More informationI know the trials in heart failure but how do I manage my patient? Dosing of neurohormones antagonists
I know the trials in heart failure but how do I manage my patient? Dosing of neurohormones antagonists Alessandro Fucili (Ferrara, IT) Massimo F Piepoli (Piacenza, IT) Clinical Case: 82 year old woman
More informationHighlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France
Highlight Session 2014 Heart failure and cardiomyopathies Michel KOMAJDA Paris France # esccongress www.escardio.org/esc2014 HEART FAILURE AND CARDIOMYOPATHIES TOPIC 1 Drug Therapy TOPIC 2 Device Therapy
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 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 informationNatriuretic Peptide Guided Therapy for Heart Failure
Natriuretic Peptide Guided Therapy for Heart Failure Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research Duke Clinical Research Institute Disclosures Research Grants
More 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 informationHeart failure: what should be changed? Prof. Gerasimos Filippatos Attikon University Hospital
Heart failure: what should be changed? Prof. Gerasimos Filippatos Attikon University Hospital Disclosures Chair or Committee Member of trials or registries sponsored by Novartis, Bayer, Cardiorentis, Servier
More informationThe Therapeutic Potential of Novel Approaches to RAAS. Professor of Medicine University of California, San Diego
The Therapeutic Potential of Novel Approaches to RAAS Inhibition in Heart Failure Barry Greenberg, M.D. Professor of Medicine University of California, San Diego Chain of Events Leading to End-Stage Heart
More informationDefinition of Congestive Heart Failure
Heart Failure Definition of Congestive Heart Failure A clinical syndrome of signs & symptoms resulting from the heart s inability to supply adequate tissue perfusion. CHF Epidemiology Affects 4.7 million
More informationCase Presentation. This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
Worsening Renal Function in Heart Failure Patients Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center
More 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 informationGerasimos Filippatos MD, FESC, FCCP, FACC
Gerasimos Filippatos MD, FESC, FCCP, FACC Head of HF Unit at Athens University Hospital, Greece President (2014-2016) of the HF Association of the European Society of Cardiology (ESC) Served as Chair of
More informationWhat s new in the 2017 heart failure guidelines. Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA
What s new in the 2017 heart failure guidelines Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA Key points to remember 2017 guidelines recommend using natriuretic peptides as biomarkers to screen for heart
More informationTreating the patient with acute heart failure. What do we really know? Principles of acute heart failure treatment
ESC 2012 27Aug - 3Sep, 2012, Munich, Germany Treating the patient with acute heart failure. What do we really know? Principles of acute heart failure treatment Marco Metra, MD, FESC Cardiology University
More 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 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 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 informationTherapeutic Targets and Interventions
Therapeutic Targets and Interventions Ali Valika, MD, FACC Advanced Heart Failure and Pulmonary Hypertension Advocate Medical Group Midwest Heart Foundation Disclosures: 1. Novartis: Speaker Honorarium
More informationMedical Management of Acute Heart Failure
Critical Care Medicine and Trauma Medical Management of Acute Heart Failure Mary O. Gray, MD, FAHA Associate Professor of Medicine University of California, San Francisco Staff Cardiologist and Training
More informationEffect of Aliskiren on Postdischarge Outcomes Among Non-Diabetic Patients Hospitalized for Heart Failure: Insights from the ASTRONAUT Outcomes Trial
Effect of Aliskiren on Postdischarge Outcomes Among Non-Diabetic Patients Hospitalized for Heart Failure: Insights from the ASTRONAUT Outcomes Trial Aldo P. Maggioni, MD, FESC Associazione Nazionale Medici
More informationARxCH. Annual Review of Changes in Healthcare. Entresto: An Overview for Pharmacists
Entresto: An Overview for Pharmacists David Comshaw, PharmD Candidate 2019 1 Gyen Musgrave, PharmD Candidate 2019 1 Suzanne Surowiec, PharmD, BCACP 1 Jason Guy, PharmD 1 1 University of Findlay College
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 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 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 informationCardiorenal Syndrome
SOCIEDAD ARGENTINA DE CARDIOLOGIA Cardiorenal Syndrome Joint session ESC-SAC ESC Congress 2012, Munich César A. Belziti Hospital Italiano de Buenos Aires I have no conflicts of interest to declare Cardiorenal
More 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 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 informationEffect of Ularitide on Cardiovascular Mortality in Acute Heart Failure (TRUE-AHF)
Effect of Ularitide on Cardiovascular Mortality in Acute Heart Failure (TRUE-AHF) Elizabeth Tien, PharmD, BCPS PGY2 Cardiology Pharmacy Resident Moses H. Cone Memorial Hospital Greensboro, NC Kristen Pogue,
More informationNatriuretic Peptides The Cardiologists View. Christopher defilippi, MD University of Maryland Baltimore, MD, USA
Natriuretic Peptides The Cardiologists View Christopher defilippi, MD University of Maryland Baltimore, MD, USA Disclosures Research support: Alere, BG Medicine, Critical Diagnostics, Roche Diagnostics,
More 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 informationNT-proBNP: Evidence-based application in primary care
NT-proBNP: Evidence-based application in primary care Associate Professor Rob Doughty The University of Auckland, Auckland City Hospital, Auckland Heart Group NT-proBNP: Evidence in Primary Care The problem
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 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 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 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 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 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 informationRenal Optimization Strategies Evaluation in Acute Heart Failure (ROSE AHF): A Randomized Clinical Trial
Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE AHF): A Randomized Clinical Trial Horng H Chen MD on behalf of the NHLBI Heart Failure Clinical Research Network Background AHF + Renal
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 informationΟξεία καρδιακή ανεπάρκεια: Ποιες παράμετροι συμβάλλουν στη διαστρωμάτωση κινδύνου των ασθενών;
Οξεία καρδιακή ανεπάρκεια: Ποιες παράμετροι συμβάλλουν στη διαστρωμάτωση κινδύνου των ασθενών; Γ. Φιλιππάτος, MD, FACC, FESC, FCCP Επ. Καθηγητής Καρδιολογίας Πανεπ. Αθηνών Clinical Outcomes in Patients
More information