Heart Failure. Optimising treatment and balancing co-morbidity in the community. Andrew Ludman Cardiologist
|
|
- Cameron Harrell
- 5 years ago
- Views:
Transcription
1 Heart Failure Optimising treatment and balancing co-morbidity in the community Andrew Ludman Cardiologist
2 What is heart failure? A structural cardiac abnormality leading to failure of the heart to provide adequate oxygen to metabolising tissues despite normal filling pressures. A syndrome in which patients have typical symptoms (e.g. breathlessness, ankle swelling, and fatigue) and signs (e.g. elevated jugular venous pressure, pulmonary crackles, and displaced apex beat) resulting from an abnormality of cardiac structure or function. Acute Chronic Hospitalised De novo Decompensated Right Left 2012 ESC HF guidelines
3 What is heart failure? Heart failure with reduced ejection fraction (HFREF) Heart failure with preserved ejection fraction (HFPEF)
4
5 Epidemic of Heart Failure?
6 Cardiovascular Disease in the UK BHF CVD Statistics Compendium 2017
7 Prevalence of HF in the UK ~550,000 people in the UK with heart failure Roughly static QOF 0.8% BHF CVD Statistics Compendium 2017 Bhatnager et al Heart
8 Heart failure mortality is probably decreasing Death registration data for: England , population 52 million people Oxford , population 2.5 million people 2015 Rahimi et al. J Epidemiol Community Health
9 1 year HF mortality in clinical trials (HFREF)
10 Mortality in community diagnosed HF Scottish GP practices 10,309 new HF diagnoses Heart failure % alive Male Female 30 days year years Mamas et al. EJHF
11 Hospitalised heart failure and mortality in UK ACALM registry of Northern England 929,552 hospitalised patients 2000 to yrs follow up AF: 31,695 HF + SR: 20,768 HF+ AF: 10, Ziff et al. Int J Card
12 Increasing inpatient episodes for heart failure BHF CVD Statistics Compendium 2017
13 Co-morbidity is (almost) universal Systems/Statistics-Trends-and-Reports/Chronic- Conditions/Downloads/2012Chartbook.pdf
14 What s new in the 2018 Chronic HF NICE guidance? 38 page summary 520 page full version Aims to be patient focussed but has some controversial areas
15 Diagnosis Algorithm NICE Chronic Heart Failure Guideline 2018 BMJ 2018;362:k3646
16 Treatment Algorithm NICE Chronic Heart Failure Guideline 2018 BMJ 2018;362:k3646
17 Roles of the Specialist MDT and Primary Care BMJ 2018;362:k3646
18 Complex patient journey requires lot s of communication Extended first specialist appointment Early follow up (~2 weeks) Sensitive and tailored discussion Early input from palliative care Clinical updates in both directions Where is your patient on this trajectory? Individualised care plan
19 Other changes to note Salt and water restriction are out egfr 45 and 30 marked as thresholds to be more careful with drug initiation (but limited evidence for this) Aiming for triple therapy for HFREF unless absolutely no symptoms Offer rehabilitation programme
20 Top Tips in HFREF Teach the patient to use weight diary First thing in the morning, post voiding, same clothes Start low and go slow does not mean taking 1 year to introduce medications Aiming for ACE-I, BB and MRA Generally ACE-I first but if particularly tachycardic then BB Edge both up every 2 weeks Renal function and BP check each time Early referral for investigation of reversible causes
21 Top Tips in HFPEF Teach the patient to use weight diary First thing in the morning, post voiding, same clothes Normalise what you can BP Heart rate Heart rhythm HbA1c Alcohol Spironolactone can be excellent for fluid, symptoms and BP If unexpected LVH or unclear cause early referral
22 Top Tips in Right heart failure Don t assume based on clinical features only Fluid balance, fluid balance, fluid balance! Avoid the downward spiral No evidence for ACE-I or BB so consider stopping Spironolactone may be a good option again May require thiazide diuretic (BDF or metolazone) Investigate and treat cause as early as possible Optimise respiratory disease Sleep apnoea? Chronic PE? ASD?
23 Top Tips for renal function Renal function checks in stable patients 1-2 weeks after dose changes Monthly for 3 months 6 monthly after this Generally need minimum 2 measures to assess trajectory Diuretics increase Ur/Cr through haemoconcentration not necessarily a change in renal function ACE-I/ARB allow up to 30% increase in Cr Check not too dry Stop non-prognostic BP meds Limited role for ACE-I/ARB/MRA in HFPEF
24 Interpreting NTproBNP results in people with suspected acute heart failure Negative predictive value 0.98 Positive predictive value 0.80 Negative predictive value 0.88 Positive predictive value 0.8 to 0.94 ng/l HF excluded HF very unlikely HF unlikely* HF likely in patients <50 years HF likely in patients <75 years HF very likely in all patients *see text Andrew Ludman 2018 age and renal function = NTproBNP
25 Diabetes and heart failure a good new option Don t start if egfr <60 Stop if egfr drops <45 Caution regarding diuretics and fluid balance Increased urinary infections BUT Reduces HF hospitalisation by up to 50% Ongoing work to refine optimal group and mechanisms Singh DOI: / Zinman B et al. N Engl J Med 2015;373:
26 Sacubitril/Valsartan A new twist on an old drug 20% reduced risk of CV death or first HF hospitalisation (ARR=4.7%) 20% reduced risk of CV mortality (ARR=3.2%) 21% reduced risk of first HF hospitalisation (ARR=2.8%) Fewer HF symptoms and a better quality of life* 1. McMurray J, et al. N Engl J Med. 2014;371: Packer M, et al. Circulation 2015;131:54 61
27 Sacubitril/Valsartan A new twist on an old drug Neurohormonal activation in heart failure Sympathetic nervous system Natriuretic peptide system NPRs Natriuretic peptide receptors Vasodilation Blood pressure Sympathetic tone Natriuresis/diuresis Vasopressin Aldosterone Fibrosis Hypertrophy NPs Natriuretic peptides Epinephrine (adrenaline) Norepinephrine (noradrenaline) α 1, β 1, β 2 receptors Vasoconstriction RAAS activity Vasopressin Heart rate Contractility Renin-angiotensin-aldosterone system Ang II AT 1 R Vasoconstriction Blood pressure Sympathetic tone Aldosterone Hypertrophy Fibrosis Ang=angiotensin; AT 1 R=angiotensin II type 1 receptor; NPs=natriuretic peptides; NPRs=natriuretic peptide receptors; RAAS=renin-angiotensinaldosterone system. 1. Levin E, et al. N Engl J Med. 1998;339: Nathisuwan S, Talbert RL. Pharmacotherapy. 2002;22: Kemp CD, Conte JV. Cardiovascular Pathology. 2012; Schrier RW, Abraham WT. N Engl J Med. 2009;341:
28 Sacubitril/Valsartan A new twist on an old drug NICE Technology Appraisal Guidance (TA388): Sacubitril/valsartan is recommended as an option for treating people with HF with reduced ejection fraction, only in people: 1 with NYHA class II to IV chronic heart failure and who are already taking a stable dose of ACEI or ARBs and with a left ventricular ejection fraction of 35% or less 1. NICE Technology Appraisal Guidance (TA388). Appraisal consultation document. Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction. April 2016 Available at: Last accessed 27 April 2016
29 Top Tips for Sacubitril/Valsartan No such thing as mild severe LVSD Outcomes are still not good Why not offer recommended optimisation of treatment? Locally has been extremely successful Anecdotally Better symptoms Less diuretics No age cut off Generally not advised with egfr <30 Does require HF cardiologist initiation currently
30 Conclusion New NICE guidelines for chronic heart failure are useful to help define healthcare roles and continue to try and increase pressure to improve services to improve outcomes Heart failure outcomes are improving but they are still not good Heart failure cardiologist plays a key role in early confirmation of diagnosis and investigation Fluid balance is crucial for any type of heart failure Treating co-morbidities will help the heart New investigations, drugs and devices available and more coming
31 Heart Failure Optimising treatment and balancing co-morbidity in the community Andrew Ludman Cardiologist
RAAS 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 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 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 informationDiagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham
Diagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Chronic heart failure
More informationNICE Chronic Heart Failure Guidelines in Adults 2018
NICE Chronic Heart Failure Guidelines in Adults 2018 The Whys, Whats and Hows of the importance of effectively managing heart failure in Primary Care and the community. Foreword Dr Clare J Taylor, General
More informationMEDICAL THERAPY IN HEART FAILURE
MEDICAL THERAPY IN HEART FAILURE Dr Lim Choon Pin MBBS, MRCP (UK), MMed (Int Med), FAMS, FESC, FACC Consultant Cardiologist, The Heart and Vascular Centre Heart Failure, Heart Transplant, Mechanical Circulatory
More informationECG in CRT patients & novel HF therapies. Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος
ECG in CRT patients & novel HF therapies Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος Dr. Konstantinou has received grants from Medtronic Is identification
More informationNew NICE Heart Failure Guidelines What do they mean for primary and secondary care, and patients?
New NICE Heart Failure Guidelines 2018 - What do they mean for primary and secondary care, and patients? Prof Ahmet Fuat PhD FRCGP FRCP PG Dip (Cardiology) GP & GPSI Cardiology Darlington Professor of
More 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 informationCritical Challenges of Acute Heart Failure
Critical Challenges of Acute Heart Failure Jonathan Howlett, MD, FRCPC, FACC Libin Cardiovascular Institute and University of Calgary President, Canadian Heart Failure Society Presenter Disclosure Faculty/Presenter:
More informationSacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC
Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Head of Cardiology Medical Manager / CV Program CHUM Disclosure Statement Within the past two years: I have had an
More 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 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 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 informationUNMET NEEDS IN THE MANAGEMENT OF HEART FAILURE
UNMET NEEDS IN THE MANAGEMENT OF HEART FAILURE By Mohammed Sadaka, MD ALEXANDRIA UNIVERSITY 2 Presentation Title Presenter Name Date Subject Business Use Only 1 HF is a complex syndrome involving multiple
More 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 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 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 informationOptimal Management of Heart Failure
Curriculum Vitae Name : Prof. DR. Dr. Idrus Alwi SpPD, K-KV, FACC, FESC, FAPSIC, FINASIM, FACP. Current Position : Professor of Internal Medicine Faculty of Medicine UI Medical Student : Faculty of Medicine
More 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 informationNew Pharmacological Developments In Heart Failure
New Pharmacological Developments In Heart Failure Diego Delgado, MD, FACC, MSc Associate Professor Site Director, Division of Cardiology Toronto General Hospital Heart Failure and Transplant Program University
More informationPRESS RELEASE. New NICE guidance will improve diagnosis and treatment of chronic heart failure
Tel: 0845 003 7782 www.nice.org.uk Ref: 2010/118 ISSUED: WEDNESDAY, 25 AUGUST 2010 PRESS RELEASE New NICE guidance will improve diagnosis and treatment of chronic heart failure The National Institute for
More informationINIBITORI NEPRILISINA
INIBITORI NEPRILISINA Marco Canepa, MD, PhD Università degli Studi di Genova Cardiologia, Ospedale Policlinico San Martino IRCCS marco.canepa@unige.it ARNI: ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITORS
More 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 informationSessions Formació Continuada en Cardiologia i Especialitats Relacionades Cardioactualitat: Noves estratègies terapèutiques en el maneig de la IC
Sessions Formació Continuada en Cardiologia i Especialitats Relacionades Cardioactualitat: Noves estratègies terapèutiques en el maneig de la IC J. Comin Colet Cap de Secció del Servei de Cardiologia i
More 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 informationai sensi dell art. 76 comma 4 dell Accordo Stato-Regioni del 2 febbraio 2017 e in accordo con il Codice Etico della SIMI dichiara
Il sottoscritto Francesco Perticone ai sensi dell art. 76 comma 4 dell Accordo Stato-Regioni del 2 febbraio 2017 e in accordo con il Codice Etico della SIMI dichiara per l evento in oggetto l esistenza
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 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 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 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 informationHFrEF and Neurohormonal Systems
HFrEF and Neurohormonal Systems Normal Control of the Circulation: Neurohumoral Balance Vasoconstrictor Salt and H 2 O retaining Vasodilator Diuretic Richard Troughton CSANZ Breakfast Symposium 15 June
More 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 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 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 informationDoes My Patient Always Require Diuretics???
Does My Patient Always Require Diuretics??? Shelley Zieroth, MD Associate Professor, Section of Cardiology Director, SBH Heart Failure and Transplant Clinics Head, Medical Heart Failure Program WRHA Cardiac
More informationTerapia Farmacologica della Insufficienza Cardiaca Cronica: è in arrivo una rivoluzione? Gennaro Cice
Terapia Farmacologica della Insufficienza Cardiaca Cronica: è in arrivo una rivoluzione? Gennaro Cice Cattedra di Cardiologia Seconda Università di Napoli 60 CONGRESSO NAZIONALE SIGG NAPOLI, 25-28 NOVEMBRE
More informationAndy Ignaszewski MD FRCPC Director, Heart Function Clinic PHC/UBC Vancouver, BC Canada
Andy Ignaszewski MD FRCPC Director, Heart Function Clinic PHC/UBC Vancouver, BC Canada Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationChronic Heart Failure Therapies: Transforming the Landscape
Chronic Heart Failure Therapies: Transforming the Landscape Dr. Nadia Giannetti Chief of Cardiology Medical Director, Heart Failure and Heart Transplant Program McGill University Health Center Conflict
More 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 Update. Chim Lang
Heart Failure Update Chim Lang Heart Failure Patient s Journey Acute Treat and stabilize Initiate monitoring Plan interventions Chronic Optimize drug and device therapy Manage Co-morbidities Subacute
More informationHeart Failure. GP Update Refresher 18 th January 2018
GP Update Refresher 18 th January 2018 Heart Failure Dr. Alexander Lyon Senior Lecturer and Consultant Cardiologist Clinical Lead in Cardio-Oncology Royal Brompton Hospital, London UK President of British
More informationWhat s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital
What s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital Disclosures I have no current or past relationships with commercial entities Learning objectives
More informationGuidelines for the Prescribing of Sacubitril / Valsartan
Hull & East Riding Prescribing Committee Guidelines for the Prescribing of Sacubitril / Valsartan 1. BACKGROUND Sacubitril valsartan is an angiotensin receptor neprilysin inhibitor, including both a neprilysin
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 informationHeart Failure Acute and Chronic
Heart Failure Acute and Chronic Cardiac Services in Wales Acute Heart Failure standards Chronic Heart Failure standards NWIS admissions/readmission data NHFA data 2016-17 Echo accessibility BNP availability
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 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 informationA Global perspective on Heart Failure: What needs to change? Martin R Cowie London, United Kingdom
A Global perspective on Heart Failure: What needs to change? Martin R Cowie London, United Kingdom Global perspective on heart failure: what needs to change? Martin R Cowie Professor of Cardiology National
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 informationChronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update)
Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update) NICE guideline Apendix C The algorithms Draft for consultation, January 2010 Chronic
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 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 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 information2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much?
2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much? Dr. Shelley Zieroth University of Manitoba @ShelleyZieroth @CanHFSociety Disclosures Consulting/Advisory Board: Amgen, Astra
More 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 informationRisk Stratification in Heart Failure: The Role of Emerging Biomarkers
Risk Stratification in Heart Failure: The Role of Emerging Biomarkers David G. Grenache, PhD Associate Professor of Pathology, University of Utah Medical Director, ARUP Laboratories Salt Lake City, UT
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 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 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 informationPravin Manga Division of Cardiology Department of Medicine University of Witwatersrand
Pravin Manga Division of Cardiology Department of Medicine University of Witwatersrand Overview Definition Epidemiology Biomarkers Treatment Clinical Heart Failure: Syndrome in which patients have typical
More 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 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 informationHeart Failure 101 The Basic Principles of Diagnosis & Management
Heart Failure 101 The Basic Principles of Diagnosis & Management Bill Tran, MD Non Invasive Cardiologist February 24, 2018 What the eye does not see and the mind does not know, does not exist. DH Lawrence
More 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 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 informationHEART FAILURE. Study day November 2017 Sarah Briggs and Janet Laing
HEART FAILURE Study day November 2017 Sarah Briggs and Janet Laing Overview and Introduction This course is an introduction and overview of heart failure. Normal heart function and basic pathophysiology
More informationSaudi Heart Failure Guidelines. Waleed AlHabeeb, MD, MHA Consultant Heart Failure Cardiologist President of the Saudi Heart Failure Group
Saudi Heart Failure Guidelines Waleed AlHabeeb, MD, MHA Consultant Heart Failure Cardiologist President of the Saudi Heart Failure Group Heart Failure Expert committee The Heart Failure Expert Committee,
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 informationHeart Failure with Reduced EF. Dino Recchia, MD, FACC, FHFSA
Heart Failure with Reduced EF Dino Recchia, MD, FACC, FHFSA Heart Failure HF is the end phenotype of almost all CV disorders Complex clinical syndrome resulting from any structural or functional impairment
More informationHeart Failure Pharmacotherapy An Update
Heart Failure Pharmacotherapy An Update Kenneth Mishler, PharmD, MBA Objectives Review the epidemiology of heart failure (HF) Review evidence based guidelines for the use of mediations used to treat HF
More informationHeart Failure Guidelines For your Daily Practice
Heart Failure Guidelines For your Daily Practice Juan M. Aranda, Jr., MD, FACC, FHFSA Professor of Medicine Director of Heart Failure and Cardiac Transplantation University of Florida College of Medicine
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 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 information2/3/2017. Objectives. Effective Heart Failure Management through Evidence Based Practice and Innovation
Effective Heart Failure Management through Evidence Based Practice and Innovation Jennifer Bauerly RN, CHFN, APRN-BC CentraCare Heart and Vascular Center Objectives Describe the scope and impact of heart
More informationL insuffisance cardiaque chez la personne âgée
L insuffisance cardiaque chez la personne âgée Congrès d automne de la SSMIG Berne, 14.09.2017 Prof. Dr. Jean-Michel Gaspoz Département de Médecine communautaire, de premier recours et des urgences Conflicts
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 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 informationEnhancing the Quality of Heart Failure Care
Enhancing the Quality of Heart Failure Care 2 Enhancing the quality of Heart Failure care Contents 2 Heart failure care in the UK: Case for change Heart failure in the UK: Case for change Heart failure
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 informationHypertension. Penny Mosley MRPharmS
Hypertension Penny Mosley MRPharmS Outline of presentation Introduction to hypertension Physiological control of arterial blood pressure What determines our bp? What determines the heart rate? What determines
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 in Women
Heart failure in Women The Melbourne Women s and Children s Update 2018 Dr Hendrik Zimmet MBBS FRACP FCSANZ Heart Failure Cardiologist Associate Clinical Dean, Monash University Central Clinical School
More informationUpdate in Cardiology What s Hot in 2017?
Update in Cardiology What s Hot in 2017? Mark R. Milunski, MD, FACC, FACP Chief, Cardiology Section Orlando Veterans Affairs Medical Center Associate Professor of Medicine University of Central Florida
More informationREVIEW ARTICLE. Sacubitril/valsartan Use for the Hospitalist Mitchell Padkins 1, James Hart 1, Rachel Littrell 2
Sacubitril/valsartan Use for the Hospitalist Mitchell Padkins 1, James Hart 1, Rachel Littrell 2 1 University of Missouri School of Medicine, Columbia, MO 2 Division of Cardiovascular Medicine, Department
More informationWHAT S NEW IN HEART FAILURE
WHAT S NEW IN HEART FAILURE Drugs, Devices and Diagnostics John M. Herre, MD, FACC, FACP Director, Advanced Heart Failure Program Sentara Helathcare Professor of Medicine Eastern Virginia Medical School
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 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 informationProof of Concept: NHS Wales Atlas of Variation for Cardiovascular Disease. Produced on behalf of NHS Wales and Welsh Government
Proof of Concept: NHS Wales Atlas of Variation for Cardiovascular Disease Produced on behalf of NHS Wales and Welsh Government April 2018 Table of Contents Introduction... 3 Variation in health services...
More information21/06/2018. MEASURING PERFORMANCE (AUDIT AND QUALITY IMPROVEMENT) Towards Reducing Inequity. What should we be measuring?
MEASURING PERFORMANCE (AUDIT AND QUALITY IMPROVEMENT) Towards Reducing Inequity Dr Raewyn Fisher Cardiologist Director of Waikato Integrated Heart Failure Service What should we be measuring? At risk,
More informationPatient details GP details Specialist details Name GP Name Dr Specialist Name Dr R. Horton
Rationale for Initiation, Continuation and Discontinuation (RICaD) Sacubitril/Valsartan (Entresto) For the treatment of symptomatic heart failure with reduced ejection fraction (NICE TA388) This document
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 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 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 informationAdvanced Heart Failure Management. Dr Andrew Hannah Consultant Cardiologist Aberdeen Royal Infirmary
Advanced Heart Failure Management Dr Andrew Hannah Consultant Cardiologist Aberdeen Royal Infirmary Grading of heart failure Mr WY age 73 3/12 dyspnoea, fatigue and some ankle oedema PMH: hypertension
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 informationHEART FAILURE IN WOMEN. Marian Limacher, MD Division of Cardiovascular Medicine University of Florida
HEART FAILURE IN WOMEN Marian Limacher, MD Division of Cardiovascular Medicine University of Florida Outline Epidemiology Clinical Overview Why HF is such a challenge State of the Field Heart Failure Adjudication
More informationNHS QIS National Measurement of Audit Acute Coronary Syndrome
NHS QIS National Measurement of Audit Acute Coronary Syndrome Things have changed based on the experience and feedback from the first cycle of measurement and, for the better we think! The Acute Coronary
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 informationCardiovascular Pharmacotherapy
Cardiovascular Pharmacotherapy Overview Mechanism of cardiovascular drugs Indications and clinical use in cardiology Renin-Angiotensin Inhibitors: Angiotensin-Converting Enzyme Inhibitors, Angiotensin
More information