Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis
|
|
- Archibald McDaniel
- 6 years ago
- Views:
Transcription
1 Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the
2 Selection of slides presented at the European Society of Cardiology Congress 2014 (Barcelona) Clinical Trial Update Hot Line: Stable CAD and atrial fibrillation 2 nd September 2014
3 Disclosures/Conflicts of interest Beta-blockers in Heart Failure Collaborative Group: The majority of the group have received speaker fees, honoraria or grant support from pharmaceutical companies involved in beta-blocker therapies. Personal: Honoraria/research grants; Menarini Farmaceutica. Steering committee lead for BB-meta-HF and the RATE-AF trial. Funding: Investigator-driven. Administrative financial support from Menarini Farmaceutica and data extraction support from GlaxoSmithKline. DK is funded by the National Institute for Health Research (NIHR); the opinions herein do not represent the views of the NIHR or the UK Department of Health.
4 Beta-blockers in heart failure Beta-blocker therapy has a class 1A recommendation for symptomatic heart failure (HF) due to reduced left-ventricular ejection fraction (LVEF). Uptake in clinical practice remains sub-optimal, with those at the greatest risk of death less likely to receive therapy. There have also been concerns over treatment efficacy in certain under-represented groups, notably women, the elderly and those with atrial fibrillation (AF). * Lee et al. JAMA. 2005;294:1240
5 Heart failure and atrial fibrillation HF and AF are two emerging epidemics of the 21 st century. AF is present in 14-50% of heart failure patients with symptoms and is closely related to NYHA class. HF patients with AF have even higher rates of death and hospitalisation, regardless of which arises first. Beta-blocker therapy in AF is advocated in current heart failure guidelines due to the benefit seen predominantly in patients with sinus rhythm. * Maisel & Stevenson. Am J Cardiol. 2003;91:2D
6 Methods Randomised controlled trials Reporting mortality as a major trial endpoint Unconfounded head-to-head Planned >6m follow-up >300 patients (accounts for >95% of eligible RCT participants) Pooling of individual data from 18,254 heart failure patients randomised to beta-blockers or placebo, according to a published extraction and analysis plan. * Excluded from sinus rhythm versus AF analysis due to study exclusion criteria Kotecha et al. Syst Rev. 2013;2:7
7 Individual patient data meta-analysis Considered the gold-standard of meta-analysis* Appropriately combine original data, thereby improving data quality. Inclusion of outcomes not originally reported. Robust examination of sub-groups with enhanced sample size. Full time-to-event analyses and generation of hazard ratios adjusted for individual baseline covariates. Stratified one-stage Cox proportional hazards model adjusted for age, gender, LVEF, heart rate and use of ACEi/ARB, presented as hazard ratios (HR) and 95% CI, censored at 40 months (3.3 years). Intention-to-treat; range of sensitivity and exploratory analyses. * Stewart & Tierney. Eval Health Prof. 2002;25:76; Simmonds et al. Clin Trials. 2005;2:209
8 Pooled baseline characteristics 18,254 individual RCT participants from 10 trials Sinus rhythm 13,946 (76.4%) AF/Flutter 3,066 (16.8%) Other rhythms 1,242 (6.8%) Heart block/paced 1,124 (6.2%) Missing ECG 118 (0.6%) No differences in any group between those allocated to beta-blockers or placebo Heart rhythm according to baseline ECG
9 Pooled baseline characteristics Characteristic Sinus rhythm (n=13,946) Atrial fibrillation (n=3,066) Age, median years (IQR) 64 (54-71) 69 (60-74) Women 25% 19% Diabetes mellitus 25% 23% Years with HF diagnosis, median (IQR) 3.0 ( ) 3.0 ( ) LVEF, median (IQR) 0.27 ( ) 0.27 ( ) NYHA class III/IV 63% 72% Systolic BP, median mmhg (IQR) 123 ( ) 127 ( ) Heart rate, median bpm (IQR) 80 (72-88) 81 (72-92) ACEi or ARB 95% 95% Any diuretic therapy 85% 94% Digoxin 53% 84% Oral anticoagulation 26% 58%
10 Mortality according to baseline rhythm Number of deaths (%) Sinus rhythm Atrial fibrillation All reported deaths 1 2,237 / 13,946 (16%) 633 / 3,066 (21%) Cause of death (% of group): Sudden death 927 (41%) 231 (37%) Heart failure 539 (24%) 184 (29%) Acute myocardial infarction 126 (6%) 13 (2%) Stroke 43 (2%) 27 (4%) Other cardiac/vascular 158 (7%) 49 (8%) Non-cardiovascular/unknown 444 (20%) 129 (20%) Deaths during study period 2 2,021 / 13,946 (14%) 556 / 3,066 (18%) 1. Mean 1.5 years until death or censoring (SD 1.1). 2. Mean 1.4 years until death or censoring (SD 1.1).
11 Hospitalisation according to baseline rhythm Hospitalisation type Sinus rhythm Atrial fibrillation CV-hospitalisation: Percentage with 1 or more admission 26% 29% Average number of admissions per patient 0.45 (range 0-16) 0.49 (range 0-14) Annualised hospitalisation rate per patient 0.52/year 0.60/year Average length of first five admissions Mean 9.7, median 6 days Mean 11.9, median 8 days HF-related hospitalisation: Percentage with 1 or more admission 16% 21% Average number of admissions per patient 0.30 (range 0-16) 0.36 (range 0-14) Annualised hospitalisation rate per patient 0.36/year 0.41/year Average length of first five admissions Mean 9.8, median 6.5 days Mean 12.0, median 8 days
12 Efficacy of beta-blockers for preventing death Unadjusted Kaplan-Meier survival (includes all reported deaths). Hazard ratios (HR) derived from the adjusted one-stage Cox model.
13 Efficacy of beta-blockers for preventing death Unadjusted Kaplan-Meier survival (includes all reported deaths). Hazard ratios (HR) derived from the adjusted one-stage Cox model.
14 Mortality outcomes Outcome Events/ sample size Sinus rhythm Beta-blockers versus placebo Atrial fibrillation Beta-blockers versus placebo Interaction AF versus sinus rhythm HR (95% CI) p-value HR (95% CI) p-value p-value All-cause mortality (all reported deaths) 2870/ (0.67, 0.80) < (0.83, 1.14) All-cause mortality (study period only) 2577/ (0.67, 0.80) < (0.79, 1.10) Cardiovascular death (all reported deaths) 2297/ (0.65, 0.79) < (0.77, 1.10) Hazard ratios derived from the one-stage Cox regression model, adjusted for age, gender, baseline LVEF, heart rate and use of ACEi/ARB.
15 Sensitivity/exploratory analyses Outcome Sinus rhythm Beta-blockers versus placebo Atrial fibrillation Beta-blockers versus placebo Interaction AF versus sinus rhythm HR (95% CI) p-value HR (95% CI) p-value p-value Additional adjustment for digoxin and oral anticoagulation 0.73 (0.67, 0.80) < (0.83, 1.14) Exclusion of BEST 0.66 (0.60, 0.74) < (0.86, 1.24) 0.74 <0.001 Exclusion of CAPRICORN 0.72 (0.66, 0.79) < (0.83, 1.15) Censor at 770 days 0.72 (0.66, 0.79) < (0.84, 1.18) 0.98 <0.001 Censor at 365 days 0.69 (0.61, 0.77) < (0.79, 1.19)
16 Sensitivity/exploratory analyses Heterogeneity: I 2 =56%, p=0.016 Heterogeneity: I 2 =0%, p=0.65 Two stage Cox regression model, adjusted for age, gender, baseline LVEF, heart rate and use of ACEi/ARB. Includes all reported deaths.
17 Sensitivity/exploratory analyses Sub-group analysis of all reported deaths for patients in AF at baseline:
18 Sensitivity/exploratory analyses Sub-group analysis of all reported deaths for patients in AF at baseline:
19 Hospitalisation, composite outcomes & stroke Outcome Events/ sample size Sinus rhythm Beta-blockers versus placebo Atrial fibrillation Beta-blockers versus placebo Interaction AF versus sinus rhythm HR (95% CI) p-value HR (95% CI) p-value p-value First CV hospitalisation 4374/ (0.73, 0.83) < (0.79, 1.04) First HF-related hospitalisation 2872/ (0.65, 0.77) < (0.78, 1.07) Death or CV hospitalisation 5670/ (0.72, 0.81) < (0.80, 1.01) CV-death or HFhospitalisation * 4151/ (0.65, 0.75) < (0.79, 1.03) Non-fatal stroke 296/ (0.78, 1.32) (0.66, 1.63) MDC does not contribute to hospitalisation or incident stroke. All deaths within study period only. * Outcome was not pre-specified.
20 Strengths & limitations Individual patient data from large, high-quality RCTs Near totality of randomised data (>95% eligible) Improved data quality, harmonised across trials Additional mortality outcomes Ability to perform adjusted time-to-event analyses Largest analysis of treatment efficacy in HF with AF Limited to data collected in the individual trials; retrospective AF group included atrial flutter (approximately 4%) Grouped according to baseline ECG; no data for AF type Missing data (minimal impact on this analysis) Insufficient patients with preserved LVEF for separate analysis of treatment efficacy (1.8% with LVEF 0.50)
21 Summary HF patients with AF have more hospital admissions, longer length of stay and higher death rates compared to sinus rhythm. For HF patients with reduced LVEF in sinus rhythm, there were clear benefits associated with beta-blocker therapy (27% reduction for incidence of death over 3.3 years). Beta-blockers in patients with concomitant AF had no significant impact on all-cause mortality, CV mortality, CV hospitalisation or HF-related hospitalisation. Our results dispute the preferential use of beta-blockers compared to other rate-control medications and suggest that current guideline recommendations should be revised.
22 Thank you for your attention The full article is now available in the Lancet journals/lancet/onlinefirst
Online Appendix (JACC )
Beta blockers in Heart Failure Collaborative Group Online Appendix (JACC013117-0413) Heart rate, heart rhythm and prognostic effect of beta-blockers in heart failure: individual-patient data meta-analysis
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More informationNCAP NATIONAL CARDIAC AUDIT PROGR AMME NATIONAL HEART FAILURE AUDIT 2016/17 SUMMARY REPORT
NCAP NATIONAL CARDIAC AUDIT PROGR AMME NATIONAL HEART FAILURE AUDIT 2016/17 SUMMARY REPORT CONTENTS PATIENTS ADMITTED WITH HEART FAILURE...4 Demographics... 4 Trends in Symptoms... 4 Causes and Comorbidities
More informationSaudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière
Prevention of Cardiovascular events with Ivabradine: The SHIFT Study Saudi Arabia February 2011 Pr Michel KOMAJDA Université Pierre et Marie Curie Hospital Pitié Salpétrière Paris FRANCE Declaration Of
More informationArbolishvili GN, Mareev VY Institute of Clinical Cardiology, Moscow, Russia
THE VALUE OF 24 H HEART RATE VARIABILITY IN PREDICTING THE MODE OF DEATH IN PATIENTS WITH HEART FAILURE AND SYSTOLIC DYSFUNCTION IN BETA-BLOCKING BLOCKING ERA Arbolishvili GN, Mareev VY Institute of Clinical
More informationThe Hearth Rate modulators. How to optimise treatment
The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,
More 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 informationPrevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient
Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient The Issue of Primary Prevention of A.Fib. (and Heart Failure) and not the Prevention of Recurrent A.Fib. after Electroconversion
More informationNational Horizon Scanning Centre. Irbesartan (Aprovel) for heart failure with preserved systolic function. August 2008
Irbesartan (Aprovel) for heart failure with preserved systolic function August 2008 This technology summary is based on information available at the time of research and a limited literature search. It
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 informationNew evidences in heart failure: the GISSI-HF trial. Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy
New evidences in heart failure: the GISSI-HF trial Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy % Improving survival in chronic HF and LV systolic dysfunction: 1 year all-cause mortality 20
More informationThe benefit of treatment with -blockers in heart failure is
Heart Rate and Cardiac Rhythm Relationships With Bisoprolol Benefit in Chronic Heart Failure in CIBIS II Trial Philippe Lechat, MD, PhD; Jean-Sébastien Hulot, MD; Sylvie Escolano, MD, PhD; Alain Mallet,
More informationβ 1 Adrenergic Receptor Polymorphism-Dependent Differences
GENETIC-AF Phase II Trial of Pharmacogenetic Guided Beta-Blocker Therapy with Bucindolol vs. Metoprolol for the Prevention of Atrial Fibrillation/Flutter in Heart Failure William T. Abraham, MD Professor
More informationSection A: Clarification on effectiveness data. Licensed population
Section A: Clarification on effectiveness data Licensed population A1: priority question Please provide the information depicted in the following table for each of the subgroups listed below (i.e., 7 tables
More informationMihai Gheorghiade MD
Mihai Gheorghiade MD Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois On behalf of: Stephen J Greene MD; Javed Butler MD MPH MBA; Gerasimos Filippatos
More informationTake-home Messages from Recent Heart Failure Trials: Heart Rate as a Target
Take-home Messages from Recent Heart Failure Trials: Heart Rate as a Target JEFFREY S. BORER, M.D. Professor and Chairman, Department of Medicine and Chief, Division of Cardiovascular Medicine; Director,
More 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 informationManagement of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA
Management of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA Declaration of potential conflict of interests Type of job or financial support Salary Ordinary funds Position in
More information12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker
12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices Heart Rate as a Cardiovascular Biomarker Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine,
More informationPharmacological Treatment for Chronic Heart Failure. Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014
Pharmacological Treatment for Chronic Heart Failure Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014 1 ACC/AHA 2005 guideline update for Diagnosis & management of CHF in the Adult -SA Hunt
More informationHeart Failure. Guillaume Jondeau Hôpital Bichat, Paris, France
Heart Failure Guillaume Jondeau Hôpital Bichat, Paris, France Epidemiology Importance of PEF Europe I-PREFER study. Abstract: 2835 Prevalence of HF Preserved LV systolic Function older (65 vs 62 y, p
More informationDigoxin And Mortality in Patients With Atrial Fibrillation With and Without Heart Failure: Does Serum Digoxin Concentration Matter?
Digoxin And Mortality in Patients With Atrial Fibrillation With and Without Heart Failure: Does Serum Digoxin Concentration Matter? Renato D. Lopes, MD, PhD, FACC on behalf of the ARISTOTLE Investigators
More informationPolypharmacy - arrhythmic risks in patients with heart failure
Influencing sudden cardiac death by pharmacotherapy Polypharmacy - arrhythmic risks in patients with heart failure Professor Dan Atar Head, Dept. of Cardiology Oslo University Hospital Ullevål Norway 27.8.2012
More informationHeart Failure in Women
Heart Failure in Women Disclosure Professor Sindone has received honoraria, speaker fees, consultancy fees, is a member of advisory boards or has appeared on expert panels for: Professor Andrew Sindone
More informationHeart Failure Medications: Who Needs What Drug Now? Disclosures
Heart Failure Medications: Who Needs What Drug Now? Simon Jackson MD FRCPC MMedEd Professor of Medicine (Cardiology) Dalhousie 1 Disclosures Honoraria and educational grants from: Actelion (medications
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 informationTreatment of Atrial Fibrillation in Heart Failure
Stockholm, September 1st 2010 Treatment of Atrial Fibrillation in Heart Failure Rhythm control: Which drugs? Stefan H. Hohnloser J.W. Goethe University Frankfurt, Germany Presenter disclosure information:
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 informationAldosterone Antagonism in Heart Failure: Now for all Patients?
Aldosterone Antagonism in Heart Failure: Now for all Patients? Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine, University of Minnesota, Director Heart Failure Program, VA Medical Center 111C
More informationManagement of atrial fibrillation in heart failure
Nationale hartfalendag 2017 Zeist Management of atrial fibrillation in heart failure Isabelle C Van Gelder University of Groningen University Medical Center Groningen The Netherlands Disclosures Grant
More informationRemote management of heart failure using implanted devices and formalized follow-up procedures (REM-HF)
Remote management of heart failure using implanted devices and formalized follow-up procedures (REM-HF) Martin R Cowie Professor of Cardiology, Imperial College London (Royal Brompton Hospital) London,
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Is there a mortality risk associated with aspirin use in heart failure? Results from a large community based cohort Margaret Bermingham, Mary-Kate Shanahan, Saki Miwa,
More informationeplerenone 25, 50mg film-coated tablets (Inspra ) SMC No. (793/12) Pfizer Ltd
eplerenone 25, 50mg film-coated tablets (Inspra ) SMC No. (793/12) Pfizer Ltd 08 June 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards
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 information» A new drug s trial
» A new drug s trial A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause
More informationEfficacy and Safety of Prescription Omega-3-Acid Esters (P-OM3) for the Prevention of Symptomatic Atrial Fibrillation
Efficacy and Safety of Prescription Omega-3-Acid Esters (P-OM3) for the Prevention of Symptomatic Atrial Fibrillation PR Kowey, JA Reiffel, KA Ellenbogen, GV Naccarelli, and CM Pratt for the OM-8 Clinical
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 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 informationRAS Blockade Across the CV Continuum
A Summary of Recent International Meetings RAS Blockade Across the CV Continuum Copyright New Evidence Presented at the 2009 Congress of the European Society of Cardiology (August 29-September 2, Barcelona)
More informationEfficacy and Safety of Prescription Omega-3-Acid Esters (P-OM3) for the Prevention of Symptomatic Atrial Fibrillation
Efficacy and Safety of Prescription Omega-3-Acid Esters (P-OM3) for the Prevention of Symptomatic Atrial Fibrillation PR Kowey, JA Reiffel, KA Ellenbogen, GV Naccarelli, and CM Pratt for the OM-8 Clinical
More informationDobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure
Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure Yuksel Cavusoglu, KU Mert, A Nadir, F Mutlu, E Gencer, T Ulus, A Birdane
More information7 th Munich Vascular Conference
7 th Munich Vascular Conference Secondary prevention of major cardiovascular events in patients with CHD or PAD - What can we learn from EUCLID and COMPASS, evaluating Clopidogrel, Ticagrelor and Univ.-Prof.
More informationThe National Heart Failure Audit 2010/2011
The National Heart Failure Audit 2010/2011 Project Steering Group; TA McDonagh, JG Cleland, HJ Dargie, S Hardman,P Mitchell, A Cunningham 85% NHS Trusts submitting data (133/156) 36,504 admissions 70%
More informationDronedarone for the treatment of non-permanent atrial fibrillation
Dronedarone for the treatment of non-permanent atrial Issued: August 2010 last modified: December 2012 guidance.nice.org.uk/ta197 NICE has accredited the process used by the Centre for Health Technology
More informationMetoprolol CR/XL in Female Patients With Heart Failure
Metoprolol CR/XL in Female Patients With Heart Failure Analysis of the Experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF) Jalal K. Ghali, MD; Ileana L.
More informationTechnology appraisal guidance Published: 28 November 2012 nice.org.uk/guidance/ta267
Ivabradine adine for treating chronic heart failure Technology appraisal guidance Published: 28 November 2012 nice.org.uk/guidance/ta267 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationHeart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist
Heart Failure Management Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart failure prevalence is expected to continue to increase¹ 21 MILLION ADULTS WORLDWIDE
More informationDisclosures. 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 informationTrials Enrolled subjects Findings Fox et al. 2014, SIGNIFY 1
Appendix 5 (as supplied by the authors): Published trials on the effect of ivabradine on outcomes including mortality in patients with different cardiovascular diseases Trials Enrolled subjects Findings
More informationConflict of interest statement
Risk of stroke, systemic embolism or death according to heart failure and left ventricular function status in patients with atrial fibrillation: results of the ARISTOTLE trial J.J.V. McMurray 1, B. Lewis
More informationHypertension Update Clinical Controversies Regarding Age and Race
Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT
More informationGeriatric Grand Rounds
Geriatric Grand Rounds Tuesday, April 13, 21 12: noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital In keeping with Glenrose Rehabilitation Hospital policy, speakers participating in this
More informationPROCORALAN MAKING A STRONG ENTRY TO THE NEW ESC GUIDELINES FOR THE MANAGEMENT OF HEART FAILURE
Press Release Issued on behalf of Servier Date: June 6, 2012 PROCORALAN MAKING A STRONG ENTRY TO THE NEW ESC GUIDELINES FOR THE MANAGEMENT OF HEART FAILURE The new ESC guidelines for the diagnosis 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 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 informationPatient characteristics Intervention Comparison Length of followup
ISCHAEMIA TESTING CHAPTER TESTING FOR MYCOCARDIAL ISCHAEMIA VERSUS NOT TESTING FOR MYOCARDIAL ISCHAEMIA Ref ID: 4154 Reference Wienbergen H, Kai GA, Schiele R et al. Actual clinical practice exercise ing
More informationBeta-blockers in heart failure: evidence put into practice
Beta-blockers in heart failure: evidence put into practice John McMurray Professor of Medical Cardiology, University of Glasgow & Consultant Cardiologist,Western Infirmary, Glasgow, UK Eugene Braunwald
More informationCADTH Canadian Drug Expert Committee Recommendation
CADTH COMMON DRUG REVIEW CADTH Canadian Drug Expert Committee Recommendation (Final) IVABRADINE HYDROCHLORIDE (LANCORA SERVIER CANADA INC.) Indication: Heart Failure, NYHA class II to III RECOMMENDATION:
More informationACC.2015 FEATURED CLINICAL RESEARCH
Effects of selective serotonin re-uptake inhibition on MOrtality, morbidity and mood in Depressed Heart Failure patients (MOOD-HF) A double-blind, randomized, placebo-controlled, parallel group study to
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
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 informationOutcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension
Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Prof. Massimo Volpe, MD, FAHA, FESC, Chair of Cardiology, Department of Clinical and Molecular Medicine
More informationAF and arrhythmia management. Dr Rhys Beynon Consultant Cardiologist and Electrophysiologist University Hospital of North Staffordshire
AF and arrhythmia management Dr Rhys Beynon Consultant Cardiologist and Electrophysiologist University Hospital of North Staffordshire Atrial fibrillation Paroxysmal AF recurrent AF (>2 episodes) that
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More informationWhat s new in 2016 Guidelines of the European Society of Cardiology? HEART FAILURE. Marc Ferrini (Lyon Fr)
What s new in 2016 Guidelines of the European Society of Cardiology? HEART FAILURE Marc Ferrini (Lyon Fr) Palermo (I) 1 04 2017 Consulting Fees, Honoraria: BAYER PHARMA BOEHRINGER INGELHEIM BRISTOL MEYERS
More informationTransient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction
Transient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction Doron Aronson MD, Gregory Telman MD, Fadel BahouthMD, Jonathan Lessick MD, DSc and Rema Bishara MD Department of Cardiology
More informationTarget dose achievement of evidencebased medications in patients with heart failure with reduced ejection fraction attending a heart failure clinic
Target dose achievement of evidencebased medications in patients with heart failure with reduced ejection fraction attending a heart failure clinic June Chen 1, Charlotte Galenza 1, Justin Ezekowitz 2,3,
More informationALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial
1 ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial Davis BR, Piller LB, Cutler JA, et al. Circulation 2006.113:2201-2210.
More informationEffect of ferric carboxymaltose on functional capacity in patients with heart failure and iron deficiency (CONFIRM-HF)
Effect of ferric carboxymaltose on functional capacity in patients with heart failure and iron deficiency (CONFIRM-HF) Piotr Ponikowski, Dirk J. van Veldhuisen, Josep Comin-Colet Georg Ertl, Michel Komajda,
More informationShould I use statins?
I know the trials in heart failure but how do I manage my patient? Should I use statins? Aldo P Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Disclosures Aldo P Maggioni served as a member of
More informationCADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION
CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION SACUBITRIL/VALSARTAN (Entresto Novartis Pharmaceuticals) Indication: Heart Failure With Reduced Ejection Fraction Recommendation: The Canadian
More informationThe LBCT of 2017 Heart Failure Trials. Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA
The LBCT of 2017 Heart Failure Trials Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA TRUE-AHF RELAX-AHF-2 Beta blockers in patients with HF with and without atrial fibrillation TRUE-AHF Additional Analysis
More informationType of intervention Treatment and secondary prevention. Economic study type Cost-effectiveness analysis.
Cost effectiveness in the treatment of heart failure with ramipril: a Swedish substudy of the AIRE study Erhardt L, Ball S, Andersson F, Bergentoft P, Martinez C. Record Status This is a critical abstract
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 informationWhat can we learn from the AVERT trial (so far)?
South West Stroke Network Event, 29 th April, 2015 What can we learn from the AVERT trial (so far)? Peter Langhorne, Professor of stroke care, Glasgow University Disclosure PL was AVERT investigator and
More informationQuality Payment Program: Cardiology Specialty Measure Set
Measure Title * Reportable via PINNACLE α Reportable via Diabetes Collaborative CQMC v1.0 Measure High Priority Measure Cross Cutting Measure Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor
More informationDisclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017
Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies
More informationRikshospitalet, University of Oslo
Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular
More informationArrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh
Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention
More informationManaging HTN in the Elderly: How Low to Go
Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular
More informationegfr > 50 (n = 13,916)
Saxagliptin and Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus and Moderate or Severe Renal Impairment: Observations from the SAVOR-TIMI 53 Trial Supplementary Table 1. Characteristics according
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 with Preserved EF (HFPEF) Epidemiology and management
Heart Failure with Preserved EF (HFPEF) Epidemiology and management Karl Swedberg Senior Professor of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg, Sweden e-mail: karl.swedberg@gu.se
More informationHF-PEF: Symptoms, quality of life and mortality/morbidity
HF-PEF: Symptoms, quality of life and mortality/morbidity May 21, 2011 John McMurray, MD Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham & Women s Hospital Boston; Visiting Professor of Medicine,
More informationQuality Payment Program: Cardiology Specialty Measure Set
Quality Payment Program: Cardiology Specialty Set Title Number CMS Reporting Method(s) Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for
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 informationPosition Statement on ALDOSTERONE ANTAGONIST THERAPY IN CHRONIC HEART FAILURE
Position Statement on ALDOSTERONE ANTAGONIST THERAPY IN CHRONIC HEART FAILURE Over 8,000 patients have been studied in two well-designed placebo-controlled outcome-driven clinical trials to evaluate the
More informationESC Guidelines. ESC Guidelines Update For internal training purpose. European Heart Journal, doi: /eurheart/ehn309
ESC Guidelines Update 2008 ESC Guidelines Heart failure update 2008 For internal training purpose. 0 Agenda Introduction Classes of recommendations Level of evidence Treatment algorithm Changes to ESC
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 informationGALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS
GALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS Table of Contents List of authors pag 2 Supplemental figure I pag 3 Supplemental figure II pag 4 Supplemental
More informationHeart failure. Complex clinical syndrome. Estimated prevalence of ~2.4% (NHANES)
Heart failure Complex clinical syndrome caused by any structural or functional impairment of ventricular filling or ejection of blood Estimated prevalence of ~2.4% (NHANES) Etiology Generally divided into
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 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 informationHeart Failure Management in T2 DM A Practical Approach. David Fitchett MD St Michael s Hospital Toronto
Heart Failure Management in T2 DM A Practical Approach David Fitchett MD St Michael s Hospital Toronto Faculty: Faculty Disclosure David Fitchett MD,, FRCP(C) Associate Professor of Medicine, University
More informationT. Suithichaiyakul Cardiomed Chula
T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial
More informationBSH Annual Autumn Meeting 2017
BSH Annual Autumn Meeting 2017 Presentation title: The Development of CRT Speaker: John GF Cleland Conflicts of interest: I have received research support and honoraria from Biotronik, Boston Scientific,
More informationCopeptin in heart failure: Associations with clinical characteristics and prognosis
Copeptin in heart failure: Associations with clinical characteristics and prognosis D. Berliner, N. Deubner, W. Fenske, S. Brenner, G. Güder, B. Allolio, R. Jahns, G. Ertl, CE. Angermann, S. Störk for
More informationIt has been shown from meta-analysis of randomized clinical trials that patients with a pre-crt QRS duration (QRSD) >150 ms benefit
Cardiac Resynchronization Therapy may be detrimental in patients with a Very Wide QRSD > 180 ms (VWQRSD) and Right Bundle Branch Block Morphology: Analysis From the Medicare ICD Registry Varun Sundaram
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 information