HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014
|
|
- Leon Anthony
- 6 years ago
- Views:
Transcription
1 HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among hospitalized pts above age 65 (nearly 2% of all admissions) Average stay 6 days w/ high readmission rate Total cost in the US >$30 billion/year Over 1million hospitalizations > half of cost Number of deaths with any mention of HF as high in 2006 as in 1995 Heart Failure (HF) A complex clinical syndrome in which the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic requirements and the venous return. Associated with episodes of decompensation interspersed with periods of relative stability Associated with significant reduction of quality of life 1
2 Mortality and HF NYHA Class IV 75% mortality at 2yrs Determinants of Cardiac Output Preload Contractility Afterload Stroke Volume Heart Rate Cardiac Output Pathophysiology of HF 2
3 Pathophysiology of HF Prevalence of HF by Gender and Age Left sided HF Types of HF Systolic > HF with reduced Ejection Fraction Diastolic > HF with preserved Ejection Fraction (EF) Acute Chronic Acute on Chronic Right Heart Failure 3
4 Types of Cardiomyopathy Dilated most common Left Ventricular dilatation Hypertrophic Ventricular muscle mass enlargement can obstruct blood flow if septal hypertrophy Restrictive least common myocardium becomes excessively "rigid (e.g. amyloidosis) Ichemic - CAD Non-ischemic Valvular disease Hypertension Diabetes Etiology (List not inclusive) Arrhythmia (tachyarrhythmia) Drugs (ETOH, cocaine, cardiotoxic meds) Infection/inflammation (myocarditis, viruses, Lupus/RA) RHF LV HF Pulmonary pathology (PAH, PE, COPD) > 75% due to CAD and HTN NYHA Functional Classification focus on exercise capacity and symptomatic status of disease 4
5 ACC/AHA Stages of HF emphasize the development and progression of disease Stage A: Patients at high risk for developing HF in the future but no functional or structural heart disorder Stage B: A structural heart disorder but no symptoms at any stage Stage C: Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment Stage D: Advanced disease requiring hospital-based support, a heart transplant or palliative care The Heart: 2 Halves with Lungs In Between Right Heart Lungs Left heart Rest of the Body Symptoms Left Ventricular Failure Exertional Dyspnea Orthopnea Paroxysmal Nocturnal Dyspnea (PND) Cough Swelling Fatigue Exercise intolerance Physical Signs Basilar Rales/crackles Jugular Venous Distension (JVD) Edema S3 Gallop Tachycardia Cheyne-Stokes Respiration 5
6 Jugular Venous Distention Pulmonary Edema/Effusions Right Ventricular Failure Symptoms Swelling Abdominal Pain Anorexia Nausea Bloating Physical Signs Peripheral Edema Jugular Venous Distention Abdominal-Jugular Reflux Hepatomegaly 6
7 B-type Natriuretic Peptide (BNP) Can help to distinguish between pulmonary disease and HF in acute setting Released by ventricles in response to ventricular volume and pressure overload Use to guide clinical decision, developing prognosis Treat the patient, not the number The Vicious Cycle of Heart Failure Management Chronic HF Diurese & Home SOB Weight Hospitalization IV Lasix or Admit PO Lasix MD s Office Emergency Room Management of HF Pharmacology Rx mainstay Start low, Go slow Goals of pharmacologic Rx Symptomatic Relief Reduce Preload Reduce systemic vascular resistance (afterload reduction) Improve morbidity and mortality Inhibition of RAAS and vasoconstrictor neurohormonal factors produced by SNS Device Therapy Biventricular Pacing/ ICDs 7
8 Daily weights General Measures Fluid and sodium restriction Weight reduction Smoking Cessation Avoid alcohol and other cardiotoxic substances Exercise Medical Considerations Treat HTN, hyperlipidemia, diabetes, anemia, arrhythmias, sleep apnea Coronary revascularization Anticoagulation Immunization Close outpatient monitoring CHF Clinic Early Follow-Up Diuretics For relief of congestive symptoms (pulmonary and peripheral edema) no mortality benefit never use as only drug for HF First choice: Loop diuretics Furosemide, bumetanide, torsemide Thiazide diuretics Chlorthalidone, metozalone Typically used in severe CHF in combination with loop diuretics for synergistic effect Potassium-sparing - spironolactone Monitor renal functions and electrolytes, esp K+ 8
9 Beta Blockers Reduce mortality and symptomatic HF For all patients with reduced Ejection Fraction (EF) with or without history of MI or ACS (recent or remote) Stages B to D and all functional classes Only three BB have shown to be effective in reducing risk of death in HF Sustained-release metoprolol ( succinate ), bisoprolol, carvedilol Blockade of excessive SNS stimulation Main side effect: bradycardia Ace Inhibitors For all patients with reduced EF with or without history of MI or ACS (recent or remote) Stages B to D and all functional classes Reduce mortality and disease progression Reduce hospitalizations RAAS blockade Monitor for hypotension, cough, hyperkalemia Lisinopril, Ramipril, Captopril, Enalapril, Fosinopril, Quinapril Angiotensin Receptor Blockers RAAS blockade No benefit in combination of ACEI and ARB (potentially harmful) Alternative for patients intolerant of ACEI due to cough or angioedema Candesartan and valsartan only ARBs recommended for ACEI substitution 9
10 Aldosterone Antagonists Shown to reduce heart failure-related morbidity and mortality Improves survival among patients with moderate to severe or chronic HF (NYHA class III IV) and HF after myocardial infarction Spironolactone, Eplerenone Side effects include hyperkalemia and gynecomastia Potassium and creatinine levels should be closely monitored in particular if used with ACEI Digoxin No longer first choice drug for HF (Class II recommendation) May be considered to reduce risk of hospitalization in patients with persistent symptoms despite maximum treatment No mortality benefit Heart Failure with Preserved LV Function (aka Diastolic Dysfunction) No convincing evidence that medical Rx reduces mortality Supportive Rx Diuretics, sodium restriction Treat HTN, CAD Ok to use calcium channel blockers for rate control in AF 10
11 Cardiac Resynchronization Therapy Biventricular pacing (with or without AICD) Added to optimal medical therapy in persistently symptomatic patients Moderate to severe HF (NYHA Class III - IV) patients QRS 130 msec LVEF 35% Improves quality of life, functional class and exercise capacity Acute decompensated HF Requires hospitalization telemetry, ICU Oxygen to maintain SPO2 > 94%; consider CPAP or BiPAP Initial Goal: symptom relief Preload and afterload reduction for symptomatic relief Diuretics loop diuretics Vasodilators - nitrates, hydralazine, nipride, nesiritide (human BNP analogue) typically reserved for hypertensive patient Inhibition of deleterious neurohormonal activation (reninangiotensin-aldosterone system [RAAS] and sympathetic nervous system) ACEI/ARB, beta-blockers, and aldosterone antagonists resulting in long-term survival benefits Hemodynamic instability may require inotropic agents and/or mechanical circulatory support (IABP, LVAD) Diuretics Mainstay of Rx for acutely decompensated HF IV administration preferred Bolus vs continuous infusion Dose based on response to first dose 2-4 hrs after it was given Increase dose or frequency if inadequate response Sometimes loop diuretic combined w/thiazide diuretic for synergistic effect Metozalone kickstarts lasix; give 30min before lasix Close monitoring of electrolytes, daily weights Transition to PO when pt reaches neareuvolemic state 11
12 Summary Heart failure is a chronic, progressive disease that is generally not curable, but treatable Most recent guidelines promote lifestyle modifications and medical management with ACE inhibitors, beta blockers, and diuretics It is estimated 15% of all heart failure patients may be candidates for cardiac resynchronization therapy. Close follow-up of the heart failure patient is essential, with necessary adjustments in medical management Stages of HF and recommended Therapy by Stage From: 2013 ACCF/AHA Guideline for the Management of Heart Failure Copyright American Heart Association, Inc. All rights reserved. Thank you! 12
HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 10/5/2015. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among
More informationHEART FAILURE. Heart Failure in the US. Heart Failure (HF) 2/20/2017. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among
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 information1/4/18. Heart Failure Guideline Review and Update. Disclosure. Pharmacist Objectives. Pharmacy Technician Objectives. What is Heart Failure?
Disclosure Heart Failure Guideline Review and Update I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation. Natalie Beiter,
More 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 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 informationA Guide to the Etiology, Pathophysiology, Diagnosis, and Treatment of Heart Failure. Part I: Etiology and Pathophysiology of Heart Failure
A Guide to the Etiology, Pathophysiology, Diagnosis, and Treatment of Heart Failure Dr Badri Paudel GMC Part I: Etiology and Pathophysiology of Heart Failure Heart Failure (HF) Definition A complex clinical
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 informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationGuideline-Directed Medical Therapy
Guideline-Directed Medical Therapy Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation OPTIMAL THERAPY (As defined in
More informationHeart failure. Failure? blood supply insufficient for body needs. CHF = congestive heart failure. increased blood volume, interstitial fluid
Failure? blood supply insufficient for body needs CHF = congestive heart failure increased blood volume, interstitial fluid Underlying causes/risk factors Ischemic heart disease (CAD) 70% hypertension
More informationHeart Failure CTSHP Fall Seminar
Heart Failure CTSHP Fall Seminar Laurajo Ryan, PharmD, MSc, BCPS, CDE Pharmacist Learning Objectives Outline the pathophysiology of heart failure List triggers for decompensated heart failure Describe
More 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 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 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 informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions.
Heart Failure Heart Failure Introduction and History AHA 2015 Statistics About 6 million Americans 870,000 new cases each year 1 in 9 deaths related to HF Almost 1 million hospitalizations each year (cost
More informationEvaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF<40%
Evaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF
More informationState-of-the-Art Management of Chronic Systolic Heart Failure
State-of-the-Art Management of Chronic Systolic Heart Failure Michael McCulloch, MD 17 th Annual Cardiovascular Update Intermountain Medical Center December 16, 2017 Disclosures: I have no financial disclosures
More informationCongestive Heart Failure 2015
Definition Congestive Heart Failure 215 JP Mehegan/ Mercy Cardiology n Cardiac failure; Congestive heart failure; Chronic heart failure (synonyms) n When the heart is unable to pump sufficiently and at
More informationIncidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction
Heart Failure Diagnosis According to the Working Group in Heart Failure, CHF is a syndrome where the diagnosis has the following essential components: A combination of: Symptoms, typically breathlessness
More informationHEART FAILURE PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
HEART FAILURE PHARMACOLOGY University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 LEARNING OBJECTIVES Understand the effects of heart failure in the body
More 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 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 informationImproving Transition of Care in Congestive Heart Failure. Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare
Improving Transition of Care in Congestive Heart Failure Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare Heart Failure Fastest growing clinical cardiac disease in the United
More informationNora Goldschlager, M.D. SFGH Division of Cardiology UCSF
CLASSIFICATION OF HEART FAILURE Nora Goldschlager, M.D. SFGH Division of Cardiology UCSF DISCLOSURES: NONE CLASSIFICATION C OF HEART FAILURE NYHA I IV New paradigm Stage A: Pts at high risk of developing
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More informationManagement Strategies for Advanced Heart Failure
Management Strategies for Advanced Heart Failure Mary Norine Walsh, MD, FACC Medical Director, HF and Cardiac Transplantation St Vincent Heart Indianapolis, IN USA President American College of Cardiology
More 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 informationCardiovascular Clinical Practice Guideline Pilot Implementation
Cardiovascular Clinical Practice Guideline Pilot Implementation Pharmacologic Management of Chronic Heart Failure Sept 15, 2004 Angela Allerman, PharmD, BCPS DoD Pharmacoeconomic Center Promoting high
More information2016 Update to Heart Failure Clinical Practice Guidelines
2016 Update to Heart Failure Clinical Practice Guidelines Mitchell T. Saltzberg, MD, FACC, FAHA, FHFSA Medical Director of Advanced Heart Failure Froedtert & Medical College of Wisconsin Stages, Phenotypes
More 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 informationObjectives. Outline 4/3/2014
Jessica Litke PGY1 ISHP Spring Meeting April 12, 2014 Objectives Appreciate the significance of heart failure (HF) to a patient and to the health care system Understand 2013 ACCF/AHA guidelines for the
More informationContemporary Management of Heart Failure. Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium
Contemporary Management of Heart Failure Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium Disclosures I have no relevant relationships with commercial
More informationHeart Failure. Dr. William Vosik. January, 2012
Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment
More informationIntroduction to Heart Failure. Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL
Introduction to Heart Failure Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL Disclosures No relevant financial relationships to disclose Objectives and Outline Define heart
More informationHeart Failure Update John Coyle, M.D.
Heart Failure Update 2011 John Coyle, M.D. Causes of Heart Failure Anderson,B.Am Heart J 1993;126:632-40 It It is now well-established that at least one-half of the patients presenting with symptoms and
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationCongestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption
Congestive Heart Failure Patient Profile Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Chief Complaint - SOB - When asked: Increasing difficulty
More informationChronic. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Michael G. Shlipak, MD, MPH
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More 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 informationThe ACC Heart Failure Guidelines
The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA
More informationHeart Failure Management Policy and Procedure Phase 1
1301 Punchbowl Street, Harkness Suite 225 Honolulu, Hawaii 96813 Phone (808) 691-7220 Fax: (808) 691-4099 www.queenscipn.org Policy and Procedure Phase 1 Policy Number: Effective Date: Revised: Approved
More informationHeart Failure. Jay Shavadia
Heart Failure Jay Shavadia Definition Clinical syndrome characterized by: Symptoms: breathlessness at rest or on exercise, fatigue, tiredness or ankle swelling AND Signs: tachycardia, tachypnea, pulmonary
More 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 informationSara O. Weiss, MD Director, Heart Failure Services Virginia Mason Medical Center September 8, 2012
Sara O. Weiss, MD Director, Heart Failure Services Virginia Mason Medical Center September 8, 2012 Disclosure: Dr. Weiss has no significant financial interest in any of the products or manufacturers mentioned.
More informationDiastolic Heart Failure. Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012
Diastolic Heart Failure Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012 Disclosures Have spoken for Merck, Sharpe and Dohme Sat on a physician advisory
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 informationCT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD
CT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD Clinical syndrome resulting from a structural or functional cardiac disorder that impairs the ability of the heart to
More informationMEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION
MEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION FRANCIS X. CELIS, D.O. OPSO FALL CONFERENCE PORTLAND, OR 16 SEPTEMBER 2017 OVERVIEW What are the ACC/AHA Stages of HF? What
More informationCLINICAL PRACTICE GUIDELINE
CLINICAL PRACTICE GUIDELINE Procedure: Congestive Heart Failure Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014
More informationDiagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta
Diagnosis & Management of Heart Failure Abena A. Osei-Wusu, M.D. Medical Fiesta Learning Objectives: 1) Become familiar with pathogenesis of congestive heart failure. 2) Discuss clinical manifestations
More informationSliwa et al. JACC 2004;44:
TREATMENT OF ADVANCED HEART FAILURE HEART DISEASE IN KENTUCKY Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac
More informationHeart Failure: Guideline-Directed Management and Therapy
Heart Failure: Guideline-Directed Management and Therapy Guideline-Directed Management and Therapy (GDMT) was developed by the American College of Cardiology and American Heart Association to define the
More informationOur Readers Have An Attitude Toward Living
February 2007 America s Wellness Guide Number 43 FREE at Doctor s Offices, Hospitals, Clinics and Kroger Pharmacies in the Midsouth COVER Standard of Care for Heart Failure Management By Arie Szatkowski,
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 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 informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy
Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationWhy guess when you could know? Gold Standard. Cardiac catheterization (Angiogram) Invasive Risks: Infection, hematoma, death
Why guess when you could know? Gold Standard Cardiac catheterization (Angiogram) Invasive Risks: Infection, hematoma, death PCI decisions Number of vessels involved Surgeon experience level The anatomic
More informationChapter 10. Learning Objectives. Learning Objectives 9/11/2012. Congestive Heart Failure
Chapter 10 Congestive Heart Failure Learning Objectives Explain concept of polypharmacy in treatment of congestive heart failure Explain function of diuretics Learning Objectives Discuss drugs used for
More informationDrugs Used in Heart Failure. Assistant Prof. Dr. Najlaa Saadi PhD pharmacology Faculty of Pharmacy University of Philadelphia
Drugs Used in Heart Failure Assistant Prof. Dr. Najlaa Saadi PhD pharmacology Faculty of Pharmacy University of Philadelphia Heart Failure Heart failure (HF), occurs when cardiac output is inadequate to
More informationHeart Failure Dr ahmed almutairi Assistant professor internal medicin dept
Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept (MBBS)(SBMD) Introduction Epidemiology Pathophysiology diastolic/systolic Risk factors Signs and symptoms Classification of HF
More informationHeart Failure Teri Diederich, APRN April 7, Objectives. Heart Failure Statistics 3/29/2016
Heart Failure Teri Diederich, APRN April 7, 2016 Objectives Verbalize heart failure statistics Understand cardiac anatomy and physiology Define heart failure and it s effects on cardiac anatomy Identify
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 informationAntialdosterone treatment in heart failure
Update on the Treatment of Chronic Heart Failure 2012 Antialdosterone treatment in heart failure 전남의대윤현주 Chronic Heart Failure Prognosis of Heart failure Cecil, Text book of Internal Medicine, 22 th edition
More informationPathophysiology: Heart Failure
Pathophysiology: Heart Failure Mat Maurer, MD Irving Assistant Professor of Medicine Outline Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology Heart Failure: Definitions
More informationUpdates in Diagnosis & Management of CHF
Updates in Diagnosis & Management of CHF N. Goldberg, DO April 30, 2011 CHF CHF is reaching an epidemic level in U.S. and continues to worsen over time Reasons are: HTN Dm with sedentary lifestyle and
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More 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 informationPeripartum Cardiomyopathy. Lavanya Rai Manipal
Peripartum Cardiomyopathy Lavanya Rai Manipal Definition - PPCM - Dilated cardiomyopathy of unknown cause resulting in cardiac failure that occurs in the peripartum period in women without any preexisting
More informationOutline. Chronic Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center Scientific
More informationOutline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies
Outline Pathophysiology: Mat Maurer, MD Irving Assistant Professor of Medicine Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology : Definitions An inability of the
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 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 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 informationTowards a Greater Understanding of Cardiac Medications Foundational Cardiac Concepts That Must Be Understood:
Towards a Greater Understanding of Cardiac Medications Foundational Cardiac Concepts That Must Be Understood: Cardiac Output (CO) CO=SVxHR (stroke volume x heart rate) Cardiac output: The amount of blood
More informationContents DEFINITION. TYPES EPIDEMIOLOGY PATHOPHYSIOLOGY. CLINICAL PRESENTATION. DIAGNOSIS. TREATMENT. EVALUATION OF THERAPEUTIC OUTCOMES.
Heart Failure Contents DEFINITION. TYPES EPIDEMIOLOGY PATHOPHYSIOLOGY. CLINICAL PRESENTATION. DIAGNOSIS. TREATMENT. EVALUATION OF THERAPEUTIC OUTCOMES. DEFINITION Heart failure (HF) is a progressive clinical
More informationLITERATURE REVIEW: HEART FAILURE. Chief Residents
LITERATURE REVIEW: HEART FAILURE Chief Residents Heart Failure EF 40% HFrEF Problem with contractility EF 40-50% HFmrEF EF > 50% HFpEF Problem with filling/relaxation RISK FACTORS Post MI HTN DM Obesity
More informationCONGESTIVE HEART FAILURE
CASE STUDY 3 CONGESTIVE HEART FAILURE For the Patient Case for this case study, see the printed book. DISEASE SUMMARY Definition Congestive heart failure (CHF) is not a specific disease but a common, progressive
More informationHypertension (JNC-8)
Hypertension (JNC-8) Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! The 8 th Joint
More 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 informationCONGESTIVE CARDIAC FAILURE. Dr.T.Rajathilagam, M.D., S.R.M. Medical College
CONGESTIVE CARDIAC FAILURE Dr.T.Rajathilagam, M.D., S.R.M. Medical College HEART FUNCTIONS Your heart is an amazing powerhouse that pumps and circulates 5 or 6 gallons of blood each minute through your
More informationAntihypertensive drugs SUMMARY Made by: Lama Shatat
Antihypertensive drugs SUMMARY Made by: Lama Shatat Diuretic Thiazide diuretics The loop diuretics Potassium-sparing Diuretics *Hydrochlorothiazide *Chlorthalidone *Furosemide *Torsemide *Bumetanide Aldosterone
More informationHEART FAILURE-UPDATES AND PRACTICAL APPROACHES TO PATIENT CARE
HEART FAILURE-UPDATES AND PRACTICAL APPROACHES TO PATIENT CARE DR DEAN T. GOROSKI, BCPS, CAPT, USPHS 2018 MPA WINTER CE AND SKI MEETING BIG SKY, MT JANUARY 6, 2018 DISCLOSURE Dr. Goroski has no actual,
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 informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
More informationCHF ICU to community. Disclosure slide CHF. Diagnosis. Diagnosis. Diagnostic modalties Therapeutic modalities. Talks. Advisory boards.
CHF ICU to community CHF Diagnostic modalties Therapeutic modalities ICU Pacer/ ICD Medication CHF clinic ASV - Nejm. Sept. 17,2015. Advanced care directives Disclosure slide Talks most companies Advisory
More informationCHF is a clinical syndrome in which heart failure is accompanied by symptoms and signs of pulmonary and/or peripheral congestion
Congestive Heart Failure Lokesh Tejwani, MD Heart Failure A patho-physiological state in which abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate
More informationAdvanced Heart Failure Palliative Considerations DEBBY GREENLAW, ACNPC, ACHPN, CCRN INDEPENDENT CONSULTANT ACUTE CARE NURSE PRACTITIONER
Advanced Heart Failure Palliative Considerations DEBBY GREENLAW, ACNPC, ACHPN, CCRN INDEPENDENT CONSULTANT ACUTE CARE NURSE PRACTITIONER Objectives Recognize functional limitations associated with the
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 informationPre-discussion questions
Amanda Bartlett, PA-C Dustin Bartlett, PA-C Andrea Applegate, PA-C Leslie Yearta Brown, NP CHF Round Table Discussion Objectives ANDREA- Discuss the definition and different categories of CHF DUSTIN- Define
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 informationProtocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year
PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart
More informationCardiac Drugs: Chapter 9 Worksheet Cardiac Agents. 1. drugs affect the rate of the heart and can either increase its rate or decrease its rate.
Complete the following. 1. drugs affect the rate of the heart and can either increase its rate or decrease its rate. 2. drugs affect the force of contraction and can be either positive or negative. 3.
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 informationHeart Failure. Dr. Alia Shatanawi
Heart Failure Dr. Alia Shatanawi Left systolic dysfunction secondary to coronary artery disease is the most common cause, account to 70% of all cases. Heart Failure Heart is unable to pump sufficient blood
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. Disclosures. Objectives: 8/28/2017. This is not a virus. It doesn t go away. none
Heart Failure This is not a virus. It doesn t go away Shelley Wojtaszczyk, FNP-C, CHFN Heart Failure Program Coordinator Mercy Hospital of Buffalo none Disclosures Objectives: Defining and identifying
More information