Advanced Heart Failure: Patient Identification and Treatment Options. Donald Haas, MD, MPH Abington - Jefferson Health Abington, PA
|
|
- Megan Rebecca Rice
- 6 years ago
- Views:
Transcription
1 Advanced Heart Failure: Patient Identification and Treatment Options Donald Haas, MD, MPH Abington - Jefferson Health Abington, PA
2 Disclosures I have received honoraria from Thoratec Corporation/St. Jude Medical, manufacturer of Heartmate II and Heartmate 3 left ventricular assist devices I will not discuss any off label products or devices
3 Advanced Heart Failure Considerations Heart failure is associated with extremely high mortality rates
4 Walking Dead Among HF outpatients One year mortality 20% Five year mortality 50% Among HF inpatients One year risk adjusted mortality 30% Chen J. JAMA 2011;306:1669 Donahoe SM. JAMA 2007;298:765
5 Heart failure is associated with very high mortality rates Among HF outpatients One year mortality 20% Five year mortality One year 50% mortality among myocardial infarction patients Among HF inpatients is only 7% One year risk adjusted mortality 30% Chen J. JAMA 2011;306:1669 Donahoe SM. JAMA 2007;298:765
6 Five-year Mortality following Hospitalization for ADHF Shahar E, et al. J Card Fail 2004;10:
7 Percent survival Survival of Stage D Heart Failure Patients with Optimal Medical Therapy
8 Mortality expectation % at One Year Rose EA, et al. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med Nov 15;345(20): Projected Mortality for Advanced Heart Failure on Par Other Terminal Diseases AIDS Leukemia Lung Cancer Pancreatic Cancer End-stage Heart Failure with Optimal Diagnosis Medical Management
9 Heart Failure: Scope of the Problem Estimated 7 million patients with HF 1 50% have HFpEF or diastolic HF 1,2 (1) Miller LW, Circulation. 2011;123: (2) AbouEzzeddine OF, et al. Congest Heart Fail. 2011;17: (3) Bhatia RS. N Engl J Med. 2006; 355:
10 Pulmonary Hypertension J Am Coll Cardiol 2012 Jan 17;59(3): Heart. 2012; 98(24):
11 Advanced Heart Failure Considerations Heart failure is associated with extremely high mortality rates Generally, advanced heart failure do not receive appropriate therapy
12 Jessup M, Brozena S. N Engl J Med. 2003;348: Stages of Heart Failure
13 Functional Class NYHA Class Class I: no functional impairment Class II: SOB at moderate exertion Class III: SOB at minimal mild exertion Class IV: SOB at rest
14 Why stages? NYHA Class Class I: no functional impairment Class II: SOB at moderate exertion Class III: SOB at minimal mild exertion Class IV: SOB at rest
15 Why stages? NYHA Class Class I: no functional impairment - NYHA Class changes Class II: SOB at moderate exertion Class III: SOB at minimal mild exertion - Inadequate as stand Class IV: SOB at rest alone descriptor of natural history
16 Jessup M, Brozena S. N Engl J Med. 2003;348: Stages of Heart Failure
17 Stage A: high risk for HF without structural heart disease or symptoms Hypertension Atherosclerotic heart disease Diabetes Obesity Metabolic syndrome Cardiotoxins (eg, doxorubicin, EtOH) Family history of cardiomyopathy
18 Jessup M, Brozena S. N Engl J Med. 2003;348: Stages of Heart Failure
19 Stage B: Structural heart disease without the development of HF Prior myocardial infarction Depressed LV ejection fraction Left ventricular hypertrophy Asymptomatic valvular heart disease
20 Jessup M, Brozena S. N Engl J Med. 2003;348: Stages of Heart Failure
21 Stage C: Structural heart disease with current or prior symptoms Needs Lasix Heart Failure Syndrome
22 CARDIOMYOPATHY IS NOT SYNONYMOUS WITH HEART FAILURE
23 Jessup M, Brozena S. N Engl J Med. 2003;348: Stages of Heart Failure
24 Stage D: refractory symptoms requiring special intervention What constitutes refractory symptoms? Repeated HF hospitalizations? Inability to complete activities of daily living? Severe sodium/fluid restriction and high diuretic requirement?
25 Jessup M, Brozena S. N Engl J Med. 2003;348: Stages of Heart Failure
26 Guideline Recommendations: Role of Inotropic Therapy in Patients with Heart Failure The routine use of inotropes as heart failure therapy is not indicated in either the short- or longterm setting The use of inotropes as a treatment of cardiogenic shock, diuretic/ace inhibitor refractory heart failure decompensations, or as a short-term bridge to definitive treatment, such as revascularization or cardiac transplantation, is potentially appropriate Inotropes may be appropriate as a palliative measure in patients with truly end-stage heart failure as part of hospice care
27 COSI* Survival *Continuous Outpatient Support with Inotropes Hershberger RE et al. J Card Fail 2003; 9:
28 IV Inotropic Agents During Hospitalization for Decompensated Heart Failure * without cardiogenic shock Treatment Failure From Adverse Event (48 h) OPTIME-CHF: In-hospital Adverse Events P < P < Sustained Hypotension 3.2 Cuffe MS et al. JAMA. 2002;287: Acute MI P = Afib Milrinone Placebo P = P = Mortality 2.3
29 Guideline Recommendations: Role of Inotropic Therapy in Patients with Heart Failure The routine use of inotropes as heart failure therapy is not indicated in either the short- or longterm setting The use of inotropes as a treatment of cardiogenic shock, diuretic/ace inhibitor refractory heart failure decompensations, or as a short-term bridge to definitive treatment, such as revascularization or cardiac transplantation, is potentially appropriate Inotropes may be appropriate as a palliative measure in patients with truly end-stage heart failure as part of hospice care
30 Stage D: refractory symptoms requiring special intervention Need for inotropes Treatments Transplant MCS/LVAD Hospice
31 Treatment Options for Stage D Heart Failure Patients Transplant Candidate MCS Candidate Hospice
32 Treatment Options for Stage D Heart Failure Patients Transplant Candidate Care as usual MCS Candidate is not an option Hospice
33 Scope of the Problem Estimated 7 million patients with HF 1 50% have HFrEF or systolic HF 1,2 10% have stage D HF Estimates vary between 5-20% 1,2 ~2200 transplants in US annually 6 ~4000 LVAD implants in US % referred to hospice Estimates vary between 12-20% (conservative) 2,3,4,5 (1) Miller LW, Circulation. 2011;123: (2) AbouEzzeddine OF, et al. Congest Heart Fail. 2011;17: (3) Setoguchi S, et al. Am Heart J. 2010;160: (4) Connor SR, et al. J Pain Symptom Manage. 2007;34: (5) Givens JL, et al. Arch Intern Med. 2010;170: (6) Taylor DO, et al. J Heart Lung Transplant. 2009;28: (7) Personal communication, Thoratec, INTERMACS
34 Scope of the Problem Estimated 7 million patients with HF 1 50% have HFrEF or systolic HF 1,2 10% have stage D HF Estimates vary between 5-20% 1,2 ~2200 transplants in US annually 6 350,000 HFrEF Stage D ~4000 LVAD implants in US % referred to hospice Estimates vary between 12-20% (conservative) 2,3,4,5 (1) Miller LW, Circulation. 2011;123: (2) AbouEzzeddine OF, et al. Congest Heart Fail. 2011;17: (3) Setoguchi S, et al. Am Heart J. 2010;160: (4) Connor SR, et al. J Pain Symptom Manage. 2007;34: (5) Givens JL, et al. Arch Intern Med. 2010;170: (6) Taylor DO, et al. J Heart Lung Transplant. 2009;28: (7) Personal communication, Thoratec, INTERMACS
35 Most advanced HF patients do not receive stage D therapies 18% of patients receive advanced HF therapies Untreated N =288,300 LVAD N = 3,500 Transplant N = 2,200 Hospice N = 56,000
36 Characteristic Death with HF All deaths (n=160) Outpt deaths (n=80) Inpt deaths (n=80) CHF clinic (mos) CHF duration (yrs) Age (yrs) Male (%) NYHA III (%) NYHA IV (%) ICD (%) CRT (%) EF (%) Deaths from 1/1/00-10/20/03 Teuteberg et al. J Card Fail 2006;12:47
37 HF Patients (%) Cancer Patients (%) Hospice prior to death Died <3 days after hospice enrollment Opiates < 60 days before death Opiates in those dying in hospital Opiates in those dying outside hospital ER visits <30 days before death Hospitalized <7 days before death Hospitalized <30 days before death ICU <30 days before death Adm SNF before death Death in acute care hospital Setoguchi S, et al. Am Heart J. 2010;160:
38 HF Patients (%) Cancer Patients (%) Hospice prior to death Died <3 days after hospice enrollment Opiates < 60 days before death Opiates in those dying in hospital Opiates in those dying outside hospital ER visits <30 days before death Hospitalized <7 days before death Hospitalized <30 days before death ICU <30 days before death Adm SNF before death Death in acute care hospital Setoguchi S, et al. Am Heart J. 2010;160:
39 HF Patients (%) Cancer Patients (%) Hospice prior to death Died <3 days after hospice enrollment Opiates < 60 days before death Opiates in those dying in hospital Opiates in those dying outside hospital ER visits <30 days before death Hospitalized <7 days before death Hospitalized <30 days before death ICU <30 days before death Adm SNF before death Death in acute care hospital Setoguchi S, et al. Am Heart J. 2010;160:
40 Hospitalizations Predict Mortality Russell SD, et al. Congest Heart Fail 2008;14:316-21
41 Russell SD, et al. Congest Heart Fail 2008;14: Hospitalizations Predict Mortality Any heart failure admission is a red flag!!
42 Impact of Hospitalizations on Mortality J Am Coll Cardiol. 2013;61(12): doi: /j.jacc Figure Legend: Median Survival Decreases Progressively After Each Hospitalization for HF Hospital admissions not only decrease quality of life, but they are also associated with shorter longevity.
43 Presence of JVD Drazner MH, et al. N Engl J Med 2001; 345:
44 Improvement of Congestion Predicts Survival in Patients With Class IV Symptoms of ADHF 146 Patients hospitalized with class IV HF 80 Assessed 4 to 6 weeks after hospitalization for congestion Patients with persistent orthopnea (n=33) 2-year survival: 38% Patients with resolution of orthopnea (n=113) 2-year survival: 77% (P=.0001) yr survival Orthop No orthop Lucas C et al. Am Heart J. 2000;140:
45 Failure to achieve euvolemia is a poor prognostic sign
46 Persistent Symptoms of Congestion at Discharge in Large Fraction of Patients Admitted for HF ADHERE 1,2 : Patients Discharged From September 1, 2002, to October 30, N=46,218 Asymptomatic 51% Improved (but still symptomatic) 39% No change <1% Not applicable <1% Worse <1% No mention 10% 1. ADHERE Registry. 3 rd Quarter National Benchmark Report Fonarow GC, for ADHERE Scientific Advisory Committee. Rev Cardiovasc Med. 2003;4(suppl 7):S21.
47 Diuretics and Mortality 100% KM Survival - Daily Diuretic Dose mg/kg 75% 50% 25% <0.5 mg/kg mg/kg 1-2 mg/kg 2-3 mg/kg 3-4 mg/kg 4+ mg/kg p< % Years Levy W, Mozaffariun D, Linker D, et al. The Seattle heart failure model. Circulation. 2006;113:
48 Predictors of Acute Mortality for Patients Admitted with Acute CHF Less than 2.68% n=25,122 BUN 43 mg/dl N=33,046 Greater than or equal to 8.98% n=7202 Less than SBP 115 mm Hg n=24, % n= % n=20,834 Greater than or equal to Less than 15.28% n=2048 SBP 115 mm Hg n= % n=5102 Greater than or equal to Fonarow GC et al. JAMA 2005;293: Less than 12.42% n=1425 SCr 2.75 mg/dl n= % n=620 Greater than or equal to
49 Proportion survival Proportion survival Diagnostic Value of Glomerular Filtration Rate in Patients With Heart Failure Days 0.0 GFR (ml/min) LVEF (%) > <44 > <20 GFRc=glomerular filtration rate estimated from serum creatinine, LVEF=left ventricular ejection fraction Hillage HL et al. Circulation 2000; 102:
50 Russell SD, et al. Congest Heart Fail 2008;14: Clues to Identifying the Potential Stage D Heart Failure Patient Two or more HF hospitalizations in 6 months Intolerant of ACE-I/ARB/Beta blocker Unable to walk 1 block or 1 flight of stairs without dyspnea (< 300 m 6MWT) Renal insufficiency (especially BUN) Increasing diuretic requirement
51 ACE/ARB Beta Blockers Aldosterone antagonists Russell SD, et al. Congest Heart Fail 2008;14: Clues to Identifying the Potential Stage D Heart Failure Patient Two or more HF hospitalizations in 6 months Intolerant of ACE-I/ARB/Beta blocker Loop diuretics Metolazone Unable to walk 1 block or 1 flight of stairs without dyspnea (< 300 m 6MWT) No clinical improvement with CRT or no CRT and QRS > 140ms
52 Triggers for Referral to Advanced HF Program J Am Coll Cardiol. 2014;63(7): Swedish HF Registry ~10000 patients NYHA III-IV (~9000 NYHA II) Age < 80 years SBP <90 mmhg Creatinine >1.8mg/dL Hemoglobin <12 g/dl No beta blocker No RAS antagonist Figure Legend: NYHA III-IV NYHA II
53 Triggers for Referral to Advanced HF Program J Am Coll Cardiol. 2014;63(7): Figure Legend: NYHA III-IV NYHA II
54 Advanced Heart Failure Considerations Heart failure is associated with extremely high mortality rates Generally, advanced heart failure do not receive appropriate therapy The crucial role of RHC in the management of heart failure
55 Low Perfusion at Rest No Yes Rapid Assessment of Hemodynamic Status Congestion at Rest No Warm & Dry Cold & Dry Yes Warm & Wet Cold & Wet Signs/symptoms of congestion Orthopnea/PND JV distension Ascites Edema Rales (rare in chronic HF) Possible evidence of low perfusion Narrow pulse pressure Sleepy/obtunded Low serum sodium PND = paroxysmal nocturnal dyspnea; JV = jugular venous. Stevenson LW. Eur J Heart Fail. 1999;1: Cool extremities Hypotension with ACE inhibitor Renal dysfunction (one cause)
56 How do you diagnose shock? Who needs an inotrope?
57 How do you diagnose shock? Who needs an inotrope? PA catheter
58 How do you diagnose shock? Who needs an inotrope? PA ESCAPE catheter
59 Clinical Outcomes in ESCAPE Six-month end points Days dead or hospitalized (mean) PAC, n=215 (%) Clinical, n=218 (%) Mortality Rehospitalizations/ patient (mean) Days in hospital (median) *No significant differences PAC=pulmonary artery catheterization; clinical=clinically guided therapy only
60 Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness: The ESCAPE Trial 26 experienced transplant cardiology centers Study of decongestion Exclusion included creatinine >3.5 mg/dl Prior use of dobutamine, milrinone Inotropes discouraged Sick cohort BP 105 EF < 30% JAMA. 2005;294(13):
61 O2 consumption [hgb][13.6][ao sat PA sat]
62 O2 consumption [hgb][13.6][ao sat PA sat] What is the O2 consumption? 108 consecutive patients Mean : 126 ml/min/m2 Wide variability: ml/min/m2 Dehmer, GJ, et al. Clin Cardiol 1982; 5:
63 CO 6, HGB 15, PA sat 70%
64 CO 6, HGB 15, PA sat 70% CO 6, HGB 10, PA sat 60%
65 CO 6, HGB 15, PA sat 70% CO 6, HGB 10, PA sat 60% CO 3, HGB 15, PA sat 50%
66 CO 6, HGB 15, PA sat 70% CO 6, HGB 10, PA sat 60% CO 3, HGB 15, PA sat 50% CO 3, HGB 10, PA sat 40%
67 Destination Therapy survival improvement over time 1 1. Jorde UP, Khushwaha SS, Tatooles AJ, et al. Two-Year Outcomes in the Destination Therapy Post-FDA-Approval Study with a Continuous Flow Left Ventricular Assist Device: A Prospective Study Using the INTERMACS Registry. Presented at the ISHLT annual meeting, April 25, 2013.
68
69 INTERMACS PROFILES INTERMACS PROFILES AND OTHER CLASSIFICATION SYSTEMS Profile # Description NYHA Class Time to MCS therapy INTERMACS 1 INTERMACS 2 INTERMACS 3 INTERMACS 4 INTERMACS 5 INTERMACS 6 INTERMACS 7 AHA/ACC Stage Crashing and burning IV Within hours D Progressive decline on inotropic support IV Within a few days D Stable but inotrope dependent IV Within a few weeks D Recurrent advanced heart failure; resting symptoms at home on oral therapy Ambulatory IV Within weeks to months Exertion intolerant Ambulatory IV Variable D Exertion limited or walking wounded Ambulatory IV Variable C-D Advanced NYHA III IIIB Variable C D Stevenson LW, Pagani FD, Young JB, et al. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant. 2009;28:
70 Interaction of Age and INTERMACS Level on Survival following CF-LVAD Implantation Source: The Journal of Heart and Lung Transplantation 2013; 32: (DOI: /j.healun ) Copyright 2013 International Society for Heart and Lung Transplantation Terms and Conditions
71 Clinical Outcomes Based on INTERMACS Profile Length of Stay Post-VAD Actuarial Survival Post-VAD Less acutely ill, ambulatory patients in INTERMACS profiles 4-7 had better survival and reduced length of stay compared to patients who were more acutely ill in profiles 1-3. Boyle, Ascheim, Russo, et.al. JHLT. 30:4, 2011.
72 It s better to refer a month too early than a week too late Transplant LVAD Hospice
73 End Stage Cancer
74 End Stage Heart Failure 74% receive ICD shock within days of death ADLER ED 2010
75 75
76 76
77 77
78 78
79 79
80 80
81 81
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation Objectives Current rationale behind use of MCS Patient Selection Earlier?
More informationRamani GV et al. Mayo Clin Proc 2010;85:180-95
THERAPIES FOR ADVANCED HEART FAILURE: WHEN TO REFER Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac Transplantation
More informationCase (Coding Nightmare) Current Dilemmas in Heart Failure : Closing the Gap between Clinical Care and Coding. Current Dilemmas in Heart Failure :
Current Dilemmas in Heart Failure : Closing the Gap between Clinical Care and Coding Interim Vice Chair for Clinical Affairs Department of Medicine, University of Florida 1 2 Case (Coding Nightmare) 69
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 informationThe Who, How and When of Advanced Heart Failure Therapies. Disclosures. What is Advanced Heart Failure?
The Who, How and When of Advanced Heart Failure Therapies 9 th Annual Dartmouth Conference on Advances in Heart Failure Therapies Dartmouth-Hitchcock Medical Center Lebanon, NH May 20, 2013 Joseph G. Rogers,
More informationKeynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes?
Keynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes? 24 th Annual San Diego Heart Failure Symposium June 1-2, 2018 La Jolla, CA Barry Greenberg, MD Distinguished Professor
More informationWHAT IS ADVANCED HEART FAILURE? James C. Fang, MD, FACC Professor and Chief Cardiovascular Division University of Utah School of Medicine
WHAT IS ADVANCED HEART FAILURE? James C. Fang, MD, FACC Professor and Chief Cardiovascular Division University of Utah School of Medicine Disclosures Data Safety Monitoring Board SOPRANO (J&J), EVALUATE-HF
More informationWHEN TO REFER FOR ADVANCED HEART FAILURE THERAPIES
WHEN TO REFER FOR ADVANCED HEART FAILURE THERAPIES Mrudula R Munagala, M.D., FACC CO- Director Heart Failure & Circulatory Support Program OklahomaHeart.com Heart Failure Prevalence Heart Failure affects
More informationPractical Points in Cardiorenal Syndrome
Practical Points in Cardiorenal Syndrome Vichai Senthong, MD. Cardiovascular Unit, Faculty of Medicine Khon Kaen university HFCT Annual Scientific Meeting June 16, 2017, Eastin Grand Sathorn Hotel, Bangkok
More informationCongestive Heart Failure: Outpatient Management
The Chattanooga Heart Institute Cardiovascular Symposium Congestive Heart Failure: Outpatient Management E. Philip Lehman MD, MPP Disclosure No financial disclosures. Objectives Evidence-based therapy
More informationHeart Failure: 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 informationHFA- ESC criteria for Advanced HF and US Requirements for Destination Therapy
HFA- ESC criteria for Advanced HF and US Requirements for Destination Therapy ESC- HFA criteria for Adv-HF Severe symptoms of HF (NYHA class III or IV) with episodes of fluid retention and/or peripheral
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 informationDisclosures. Objectives. What is Heart Failure? Best Practices for Managing Patients
Disclosures Best Practices for Managing Patients with Advanced Heart Failure I have no financial disclosures Site PI for observational heart failure study sponsored by Thoratec James O. Mudd, MD Assistant
More informationAcute Circulatory Support Should We or Shouldn t We?
Acute Circulatory Support Should We or Shouldn t We? Navin K. Kapur, MD, FACC, FSCAI Assistant Professor, Division of Cardiology Director, Acute Circulatory Support Program Director, Interventional Research
More informationContemporary Clinical Pearls in Physical Diagnosis: A Multi-Media Look at Actual Findings & Sounds, Hemodynamics, and What the Literature Has to Say
Contemporary Clinical Pearls in Physical Diagnosis: A Multi-Media Look at Actual Findings & Sounds, Hemodynamics, and What the Literature Has to Say James C. Fang, MD Harrington Heart and Vascular Institute
More informationMechanical Circulatory Support in the Management of Heart Failure
Mechanical Circulatory Support in the Management of Heart Failure Feras Bader, MD, MS, FACC Associate Professor of Medicine Director, Heart Failure and Transplant Cleveland Clinic Abu Dhabi Chairman, Heart
More informationPivotal Role of Renal Function in Acute Heart failure
Pivotal Role of Renal Function in Acute Heart failure Doron Aronson MD, FESC Department of Cardiology RAMBAM Health Care Campus Haifa, Israel Classification and definitions of cardiorenal syndromes CRS
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 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 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 informationHeart Failure Update. Bibiana Cujec MD May 2015
Heart Failure Update Bibiana Cujec MD May 2015 Disclosures Participation in clinical trial GUIDE IT (BNP in management of HF) Plan Review of new trials/ccs guidelines Management of heart failure: cases
More informationIntravenous Inotropic Support an Overview
Intravenous Inotropic Support an Overview Shaul Atar, MD Western Galilee Medical Center, Nahariya Affiliated with the Faculty of Medicine of the Galilee, Safed, Israel INOTROPES in Acute HF (not vasopressors)
More informationSummary/Key Points Introduction
Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification
More informationHeart Failure and Renal Disease Cardiorenal Syndrome
Advanced Heart Failure: Clinical Challenges Heart Failure and Renal Disease Cardiorenal Syndrome 17 th Apr 2015 Ju-Hee Lee, M.D Cardiovascular Center, Chungbuk National University Hospital Chungbuk National
More informationLVADS IN AMBULATORY PATIENTS CLASS III PATIENT SHOULD UNDERGO LVAD IMPLANTATION
LVADS IN AMBULATORY PATIENTS CLASS III PATIENT SHOULD UNDERGO LVAD IMPLANTATION Ajith Nair MD Baylor College of Medicine / Texas Heart Institute American Association for Thoracic Surgery Mechanical Circulatory
More informationLessons learned from ENDURANCE, ROADMAP, MedaMACS, and how to go forward?
Lessons learned from ENDURANCE, ROADMAP, MedaMACS, and how to go forward? Mark S. Slaughter, MD Professor and Chair Department of Cardiovascular and Thoracic Surgery University of Louisville What could
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 information3/2/2017. Identifying the Patient for Advanced Therapies. Why is Identifying the Adv HF patient important? CHF Stages and Steps of Treatment
Identifying the Patient for Advanced Therapies Cindy Bither Chief NP- Adv HF Program Medstar Heart and Vascular Institute Stage A High risk with no symptoms Stage B Structural heart disease, no symptoms
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 informationPearls in Acute Heart Failure Management
Pearls in Acute Heart Failure Management Best Practices Juan M. Aranda Jr., M.D. Professor of Medicine Medical Director of Heart Failure/ Transplant Program University of Florida College of Medicine Disclosures:
More informationAdvanced Heart Failure Therapies 2017: Diuretics to LVAD and Everything in Between
Advanced Heart Failure Therapies 2017: Diuretics to LVAD and Everything in Between George G. Sokos, DO FACC Director, Advanced Heart Failure Associate Professor of Medicine West Virginia University Outline
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 informationNew Advances in the Diagnosis and Management of Acute and Chronic Heart Failure
New Advances in the Diagnosis and Management of Acute and Chronic Heart Failure Deborah Budge, MD Intermountain Healthcare Heart Failure Cardiologist Objectives: State the updates from the ACC 2013 HF
More informationMechanical assist patient selection, device selection, and outcomes
Mechanical assist patient selection, device selection, and outcomes Josef Stehlik, MD, MPH Associate Professor of Medicine Medical Director, Heart Transplant Program University of Utah School of Medicine
More informationTips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance
Tips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance J. Parissis Attikon University Hospital, Athens, Greece Disclosures ALARM investigator received
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 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 informationTreating the patient with acute heart failure. What do we really know? Principles of acute heart failure treatment
ESC 2012 27Aug - 3Sep, 2012, Munich, Germany Treating the patient with acute heart failure. What do we really know? Principles of acute heart failure treatment Marco Metra, MD, FESC Cardiology University
More 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 information5 Important Things to Know About Heart Failure. Kia Afshar, MD
5 Important Things to Know About Heart Failure Kia Afshar, MD Disclosures I have no conflicts of interest to disclose I will not be discussing any off label medications and/or devices Objectives 1) Understand
More information2018 Update on Heart Failure Management. Where we are today.
2018 Update on Heart Failure Management Where we are today. Mitchell Saltzberg, MD Medical Director Comprehensive Heart Failure and Transplant Program HEART FAILURE 1 Current State of Heart Failure 5.7M
More informationSurgery and device intervention for the elderly with heart failure: assessing the need. Devices and Technology for heart failure in 2011
Surgery and device intervention for the elderly with heart failure: assessing the need Devices and Technology for heart failure in 2011 Assessing cardiovascular function / prognosis (in the elderly): composite
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 Medical and Surgical Treatment
Heart Failure Medical and Surgical Treatment Daniel S. Yip, M.D. Medical Director, Heart Failure and Transplantation Mayo Clinic Second Annual Lakeland Regional Health Cardiovascular Symposium February
More informationCHANGING THE WAY HEART FAILURE IS TREATED. VAD Therapy
CHANGING THE WAY HEART FAILURE IS TREATED VAD Therapy VAD THERAPY IS BECOMING AN ESSENTIAL PART OF HEART FAILURE PROGRAMS AROUND THE WORLD. Patients with advanced heart failure experience an impaired quality
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 informationManagement of Advanced Systolic Heart Failure. Robert W. Hull MD FACC Associate Professor of Medicine West Virginia University
Management of Advanced Systolic Heart Failure Robert W. Hull MD FACC Associate Professor of Medicine West Virginia University American College of Cardiology Foundation (ACCF) American Heart Association
More 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 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 informationPredicting Outcomes in LVAD Recipients
Predicting Outcomes in LVAD Recipients Sean P. Pinney, MD Director, Advanced Heart Failure & Cardiac Transplantation Professor of Medicine, Cardiology Icahn School of Medicine at Mount Sinai New York,
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 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 informationRecent Successes in Heart Failure
Recent Successes in Heart Failure Samer S. Najjar, M.D. Medical Director, Heart Failure and Heart Transplantation MedStar Heart and Vascular Institute MedStar Washington Hospital Center May 30, 2015 Presenter
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 informationThe Interface of Cardiology and Palliative Medicine
The Interface of Cardiology and Palliative Medicine Nathan Goldstein, MD Associate Professor Hertzberg Palliative Care Institute Brookdale Department of Geriatrics and Palliative Medicine Mount Sinai School
More informationHEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading
More 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 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 informationAllinaHealthSystem 1
: Definition End-organ hypoperfusion secondary to cardiac failure Venoarterial ECMO: Patient Selection Michael A. Samara, MD FACC Advanced Heart Failure, Cardiac Transplant & Mechanical Circulatory Support
More informationDevice Therapy for Heart Failure
Device Therapy for Heart Failure Dr. Shelley Zieroth FRCPC Assistant Professor, Cardiology, University of Manitoba Director of Cardiac Transplant and Heart Failure Clinics St Boniface General Hospital,
More informationWhat Is Best Care for Patients with End stage heart failure?
What Is Best Care for Patients with End stage heart failure? Jin Joo Park, MD Cardiovascular Center, Department of Internal Medicine Bundang Hospital NYHA Class Class Patient Symptoms I No limitation 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 informationHeart Failure Therapies State of the Art 2017
Heart Failure Therapies State of the Art 2017 Andrew J. Sauer, MD Assistant Professor Director, Center for Heart Failure Medical Director, Heart Transplantation UNOS Primary Transplant Physician asauer@kumc.edu
More informationEjection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction
Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Keith Miller MD Diastolic Heart Failure Risk Factors Common Risk Factors Aging Female gender Obesity Hypertension Diabetes mellitus
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. 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 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 informationCONGESTIVE HEART FAILURE
CONGESTIVE HEART FAILURE ACOI IM BOARD REVIEW 2018 MARTIN C. BURKE, DO, FACOI DISCLOSURES I AM PRINCIPAL INVESTIGATOR AND RECEIVE GRANTS FOR HEART FAILURE TRIALS FROM BOSTON SCIENTIFIC, MEDTRONIC AND ST
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 informationManagement of acute decompensated heart failure and cardiogenic shock. Arintaya Phrommintikul Department of Medicine CMU
Management of acute decompensated heart failure and cardiogenic shock Arintaya Phrommintikul Department of Medicine CMU Acute heart failure: spectrum Case 64 y/o M with Hx of non-ischemic DCM (LVEF=25-30%)
More informationVentricular Assist Devices
Page 1 By Tonya Elliott, RN, MSN Background, Indications for VADs Mechanical circulatory support has become an acceptable therapy for end stage heart failure (HF) in maximally medically treated patients
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 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 informationThe role of remote monitoring in preventing readmissions after acute heart failure
The role of remote monitoring in preventing readmissions after acute heart failure October 20, 2017 Randall C Starling MD MPH FACC FAHA FESA FHFSA Professor of Medicine Kaufman Center for Heart Failure
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 informationManagement of Acute Heart Failure
Management of Acute Heart Failure Uri Elkayam, MD Professor of Medicine University of Southern California School of Medicine Los Angeles, California elkayam@usc.edu ADHF Treatments Goals.2 Improve symptoms.
More informationChronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
More informationHeart Failure: 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 informationCASE STUDIES IN ADVANCED HEART FAILURE
CASE STUDIES IN ADVANCED HEART FAILURE Navin Rajagopalan, MD Director, Congestive Heart Failure Medical Director, Cardiac Transplantation Gill Heart Institute, Cardiovascular Medicine DISCLOSURES NOTHING
More informationNew CHF Patient in my Office: What Should I Do?
New CHF Patient in my Office: What Should I Do? Joseph Mishkin MD FACC Advanced Heart Failure, Transplantation and Mechanical Circulatory Support No disclosures Disclosures Clinical Presentation 38 year
More informationManagement of Severe Heart Failure Exacerbation
Management of Severe Heart Failure Exacerbation Rocky Mountain Hospital Medicine Symposium November 5, 2017 Larry A. Allen, MD. MHS Medical Director, Advanced Heart Failure Presenter Disclosure Information
More informationHeart failure (HF) affects more
doi: 10.1111/j.1751-7133.2008.00022.x R EVIEW P APER Advanced Heart Failure: A Call to Action Heart failure (HF) affects more than 5 million patients in the United States and is associated with high morbidity
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 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 informationInnovation therapy in Heart Failure
Innovation therapy in Heart Failure P. Laothavorn September 2015 Topics of discussion Basic Knowledge about heart failure Standard therapy New emerging therapy References: standard Therapy in Heart Failure
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 informationWhat s new in the 2017 heart failure guidelines. Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA
What s new in the 2017 heart failure guidelines Prof.Dr.Mehmet Birhan YILMAZ, FESC, FACC, FHFA Key points to remember 2017 guidelines recommend using natriuretic peptides as biomarkers to screen for heart
More 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 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 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 informationObjectives. Systolic Heart Failure: Definitions. Heart Failure: Historical Perspective 2/7/2009
Objectives Diastolic Heart Failure and Indications for Echocardiography in the Asian Population Damon M. Kwan, MD UCSF Asian Heart & Vascular Symposium 02.07.09 Define diastolic heart failure and differentiate
More informationCardiorenal Syndrome: What the Clinician Needs to Know. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Cardiorenal Syndrome: What the Clinician Needs to Know William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Renal Hemodynamics in Heart Failure Glomerular
More informationRecognizing and Treating Patients with the Cardio-Renal Syndrome
Recognizing and Treating Patients with the Cardio-Renal Syndrome Joachim H. Ix, MD, MAS, FASN Professor of Medicine Chief; Division of Nephrology-Hypertension University of California San Diego 1 Conflicts
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 informationΟξεία Καρδιακή Ανεπάρκεια: Κλινική εικόνα, ταξινόμηση κινδύνου & προγνωστικοί δείκτες
Οξεία Καρδιακή Ανεπάρκεια: Κλινική εικόνα, ταξινόμηση κινδύνου & προγνωστικοί δείκτες Στράτος Θεοφιλογιαννάκος, MD, PhD Ιατρείο Καρδιακής Ανεπάρκειας, Γ Πανεπιστημιακή Καρδιολογική Κλινική ΑΠΘ, ΠΓΝ Ιπποκράτειο
More informationMechanical Cardiac Support in Acute Heart Failure. Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research
Mechanical Cardiac Support in Acute Heart Failure Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research Disclosures Research Support and/or Consulting NHLBI Amgen Cytokinetics
More informationAbby Woods, DNP, FNP Southern Illinois Healthcare Supportive Care Program END OF LIFE ISSUES IN THE CARE OF CARDIAC PATIENTS
Abby Woods, DNP, FNP Southern Illinois Healthcare Supportive Care Program END OF LIFE ISSUES IN THE CARE OF CARDIAC PATIENTS Objectives Describe a team approach in the setting of critical illness Differentiate
More informationOptimizing CHF Therapy: The Role of Digoxin, Diuretics, and Aldosterone Antagonists
Optimizing CHF Therapy: The Role of Digoxin, Diuretics, and Aldosterone Antagonists Old Drugs for an Old Problem Jay Geoghagan, MD, FACC BHHI Primary Care Symposium February 28, 2014 None. Financial disclosures
More information