Balanced information for better care. Heart failure: Managing risk and improving patient outcomes
|
|
- Clarissa Floyd
- 5 years ago
- Views:
Transcription
1 Balanced information for better care Heart failure: Managing risk and improving patient outcomes
2 Heart failure increases hospitalization Heart failure is the most common medical reason for hospitalization and the most costly diagnosis among Medicare patients. 1 FIGURE 1. Annual hospital admissions for common Medicare diagnoses 1 5, 4, Admissions 3, 2, 1, Heart failure Pneumonia COPD Arrhythmia Acute MI More than 16% of Pennsylvania residents over age 65 have heart failure (HF). 2 FIGURE 2. Treating heart failure is expensive. Total medical costs of HF topped $31 billion in 212, and are expected to exceed $7 billion by Direct medical costs = $21 billion 18% Morbidity Indirect medical costs = $1 billion 54% 14% Mortality Hospitalization 14% Outpatient 2 Heart failure
3 Heart failure is progressive Optimal management is based on stage and ejection fraction (EF): Heart failure with reduced ejection fraction (HFrEF) 4% EF systolic HF Heart failure with preserved ejection fraction (HFpEF) 5% EF diastolic HF FIGURE 3. Stages of heart failure guide appropriate management strategy. 4 STAGE DESCRIPTION GOAL STAGE A At risk for developing HF Prevent HF by treating risk factors. Prevention STAGE B Asymptomatic with structural heart disease* Treat with beta blockers and ACE inhibitors or ARBs to prevent progression to HF in patients with reduced EF. Heart failure STAGE C STAGE D Symptomatic prior or current symptoms of HF Refractory or advanced HF Use evidence-based treatments to reduce symptoms and improve outcomes. Refer to specialists for advanced therapies when indicated and discuss goal-directed care with patients. Source: American College of Cardiology Foundation and American Heart Association * Structural heart disease: left ventricular (LV) hypertrophy, LV dysfunction, prior myocardial infarction, or valvular disease ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blocker Alosa Foundation Balanced information for better care 3
4 STAGE A: Patients at risk for developing heart failure Recognize and treat HF risk factors FIGURE 4. Risk factors for developing heart failure 5 Hazard ratio for developing HF Coronary heart disease 3.5 Diabetes 3.2 LV hypertrophy 2.7 Valvular disease 2.3 Treated hypertension 2.1 Currently smoking Treat modifiable risk factors: comorbid conditions (e.g., coronary heart disease, hypertension, diabetes) behaviors (e.g., smoking, lack of physical activity, diet with excessive calories and/or salt) FIGURE 5. Treating blood pressure over 15 mmhg systolic resulted in a 64% decrease in HF in older patients. 6 7 HF episodes per 1 patients p<.1 placebo treated 64 % 64 HF episodes per 1 people prevented by treating hypertension Years of follow-up 4 Heart failure
5 STAGE B: Asymptomatic patients with structural heart disease Managing comorbidities benefits asymptomatic patients Patients with reduced EF require treatment: Begin with an ACE inhibitor. FIGURE 6. An ACE inhibitor reduces the risk of progression to HF or death in patients with low EF (<35%) by 29%. 7 5 placebo 4 p<.1 29 % Risk reduction Death or CHF (%) enalapril Months Use an ARB for patients who cannot tolerate an ACE inhibitor. Beta blockers also slow progression to HF by 14%. 8 Alosa Foundation Balanced information for better care 5
6 STAGE C: Symptomatic patients Symptomatic patients: Self care is critical monitoring signs and symptoms of HF (e.g., daily weights) limiting sodium exercising as tolerated (independently or in a cardiac rehabilitation program) adhering to the prescribed regimen FIGURE 7. Algorithm for pharmacologic treatment in HF with reduced EF INITIAL THERAPY ACE inhibitor (or ARB) loop diuretic for volume control beta blocker* Optimize ACE inhibitor / ARB and beta blocker doses CONTINUE IF SYMPTOMATIC aldosterone antagonist If GFR > 3 and K+ < 5 Stop ACEI or ARB and start sacubitril / valsartan Add digoxin and / or ivabradine Use ivabradine for patients with HR > 7 on maximally tolerated beta blockers African Americans with moderate to severe symptoms hydralazine / isosorbide dinitrate Refer to cardiology for consideration of advanced therapies * Trials enrolled patients with symptoms, but current guidelines recommend the use of beta blockers in most HF patients. Titrate ACE inhibitors and beta blockers to maximally tolerated dose to achieve the greatest mortality benefit. 9,1 Even a low dose of these drugs is better than no dose. 6 Heart failure
7 The quality of evidence varies by drug TABLE 1. Evidence summary for pharmacologic treatment of HF Medication Efficacy ref* pef** Target dose Monitor ACE inhibitor or ARB n highest tolerated dose while maintaining adequate BP serum potassium; renal function beta blocker (bisprolol, carvedilol, metoprolol XL) n highest dose tolerated for heart rate heart rate diuretics (bumetanide, furosemide, torsemide) n n as needed for symptom control volume status; serum potassium; renal function aldosterone antagonist (spironolactone, eplerenone) n serum potassium; renal function sacubitril / valsartan n highest tolerated dose while maintaining adequate BP serum potassium hydralazine / isosorbide dinitrate highest tolerated dose while maintaining adequate BP digoxin use lower doses in older patients renal function; digoxin level ivabradine highest tolerated for heart rate heart rate *ref = reduced EF, systolic HF **pef = preserved EF, diastolic HF Use ACE inhibitors before using an ARB. Reduces mortality and hospitalization Reduces mortality and hospitalization in African Americans No reduction in mortality or hospitalization No data available Reduces hospitalization but not mortality Other treatment options for patients with heart failure with reduced ejection fraction: Implantable cardioverter defibrillators (ICDs) improve survival in symptomatic HF patients and asymptomatic patients who are post myocardial infarction (MI). 11 In HF patients with prolonged QRS, cardiac resynchronization therapy (CRT) increases survival up to 36%. 12 Alosa Foundation Balanced information for better care 7
8 STAGE C: Symptomatic patients, continued New treatment options for symptomatic patients with reduced EF (ref) Sacubitril / valsartan FIGURE 8. In PARADIGM-HF, sacubitril / valsartan reduced mortality and hospitalization. 13 Ivabradine FIGURE 9. In SHIFT, ivabradine decreased hospitalization for worsening HF. CV death or HF hospitalization (%) HR.8; p<.1 22 % sacubitril / valsartan 27 % enalapril Patients with first hospital admission for worsening heart failure (%) HR.74; p<.1 placebo ivabradine Months For patients with reduced EF who continue to be symptomatic on optimal medical therapy, sacubitril / valsartan replaces the ACE inhibitor or ARB. Ivabradine is limited to patients on maximally tolerated beta blocker therapy with heart rates > Managing patients with preserved EF (pef) Treat hypertension. Use diuretics to control symptoms: Monitor for hypovolemia and hypotension. Patients with preserved EF may be more sensitive to diuretics and dihydropyridine calcium channel blockers (e.g., amlodipine, nifedipine) than patients with reduced EF. Control heart rate in patients with atrial fibrillation. Treat symptomatic ischemic heart disease. 8 Heart failure
9 STAGE D: Refractory heart failure Weigh risks and benefits of advanced therapy: Discuss goals of care Half of patients admitted for HF are rehospitalized within 6 months. 15 Advanced or refractory HF care should focus on quality of life: determine if mechanical circulatory support is an option reduce time in the hospital review end of life goals when appropriate discuss palliative care if indicated Options for advanced therapy include: continuous infusion inotropes left ventricular assist device heart transplant FIGURE 1. More patients have been using hospice rather than hospital at the end of life. However, a growing proportion of hospitalized patients were in the ICU Care received at the time of death (%) Intensive care unit (ICU) Non-ICU inpatient Hospice Alosa Foundation Balanced information for better care 9
10 Costs FIGURE 11. Cost of a 3-day supply of medications used in managing heart failure metoprolol succinate (generic) 15mg $77 Beta blockers metoprolol (Toprol XL) 15mg carvedilol (generic) 37.5mg carvedilol (Coreg) 37.5mg carvedilol CR (Coreg CR) 4mg bisoprolol (generic) 1mg $1 $34 $123 $262 $364 bisoprolol (Zebeta) 1mg $162 ACE inhibitors lisinopril (generic) 1mg lisinopril (Zestril) 1mg enalapril (generic) 1mg ramipril (generic) 2.5mg ramipril (Altace) 2.5mg captopril (generic) 5mg $4 $6 $35 $33 $125 $375 candesartan (Atacand) 8mg $17 candesartan (generic) 8mg $84 ARBs losartan (generic) 5mg losartan (Cozaar) 5mg $37 $11 valsartan (generic) 8mg $127 valsartan (Diovan) 8mg $25 Diuretics Aldosterone antagonists spironolactone (generic) 75mg spironolactone (Aldactone) 75mg eplerenone (generic) 5mg eplerenone (Inspra) 5mg metolazone (generic) 5mg metolazone (Zaroxolyn) 5mg hydrochlorothiazide (generic) 25mg bumetanide (generic) 1mg torsemide (generic) 1mg torsemide (Demadex) 1mg $1 $44 $4 $27 $21 $66 $14 $114 $158 $24 furosemide (generic) 4mg $4 furosemide (Lasix) 4mg $29 digoxin (generic).25mg $34 digoxin (Lanoxin).25mg $224 Other drugs hydralazine+isosorbide dinitrate (Bidil) 112.5/6mg hydralazine (generic) 112.5mg isosorbide dinitrate (generic) 6mg ivabradine (Corlanor) 1mg $1 $81 $2 $383 sacubitril/valsartan (Entresto) 97mg/13mg $392 Prices from goodrx.com, November 215. Listed doses are based on Defined Daily Doses by the World Health Organization, and should not be used for dosing in all patients. 1 Heart failure
11 Key messages Identify risk factors for heart failure such as hypertension, diabetes, and atrial fibrillation and treat them to prevent or delay the development of heart failure. In HF with reduced EF, titrate beta blockers and either ACE inhibitors or ARBs to doses used in studies, or the maximally tolerated dose. Patients who have symptomatic HF with reduced EF even when on an ACE inhibitor or ARB may be candidates for sacubitril / valsartan (Entresto) to replace their ACE inhibitor or ARB. In HF with preserved EF, treat hypertension and manage other comorbidities to control symptoms. Diuretics are useful to maintain fluid balance in patients who have HF with both preserved and reduced EF. After HF hospitalization, address possible medication non-adherence, review weight goals, and reinforce salt or fluid restriction. Discuss goals of care and advance directives for patients with severe, end-stage HF. Visit alosafoundation.org/modules/heartfailure for links to additional resources and a longer evidence document References: (1) Centers for Medicare & Medicaid Services. Medicare Provider Utilization and Payment Data: Inpatient. Accessed November 2, 215. (2) CMS/Office of information products and data analytics. Medicare chronic conditions dashboard: state level. Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Chronic-Conditions-State/CC_State_Dashboard.html. Accessed September 22, 215. (3) Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 213;6(3): (4) Yancy CW, Jessup M, Bozkurt B, et al. 213 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 213;128(16):e (5) Agarwal SK, Chambless LE, Ballantyne CM, et al. Prediction of incident heart failure in general practice: the Atherosclerosis Risk in Communities (ARIC) Study. Circ Heart Fail. 212;5(4): (6) Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 8 years of age or older. N Engl J Med. 28;358(18): (7) The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327(1): (8) Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 21;357(9266): (9) Packer M, Poole-Wilson PA, Armstrong PW, et al. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation. 1999;1(23): (1) Bristow MR, Gilbert EM, Abraham WT, et al. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators. Circulation. 1996;94(11): (11) Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 25;352(3): (12) Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 25;352(15): (13) McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 214;371(11): (14) Swedberg K, Komajda M, Bohm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 21;376(9744): (15) Desai AS, Stevenson LW. Rehospitalization for Heart Failure: Predict or Prevent? Circulation. 212;126(4): (16) Unroe KT, Greiner MA, Hernandez AF, et al. Resource use in the last 6 months of life among medicare beneficiaries with heart failure, Arch Intern Med. 211;171(3): Alosa Foundation Balanced information for better care 11
12 About this publication These are general recommendations only; specific clinical decisions should be made by the treating physician based on an individual patient s clinical condition. More detailed information on this topic is provided in a longer evidence document at alosafoundation.org. The Independent Drug Information Service (IDIS) is supported by the PACE Program of the Department of Aging of the Commonwealth of Pennsylvania. This material is provided by the Alosa Foundation, a nonprofit organization which is not affiliated with any pharmaceutical company. IDIS is a program of the Alosa Foundation. This material was produced by Jennifer Lewey, M.D., Research Fellow, Brigham and Women s Hospital; Michael A. Fischer, M.D., M.S., Associate Professor of Medicine (principal editor); Jerry Avorn, M.D., Professor of Medicine; Niteesh K. Choudhry, M.D., Ph.D., Associate Professor of Medicine, all at Harvard Medical School; and Ellen Dancel, PharmD, MPH, Director of Clinical Material Development at the Alosa Foundation. Drs. Avorn, Choudhry, and Fischer are physicians at the Brigham and Women s Hospital in Boston, and Dr. Lewey practices cardiology at the Columbia University Medical Center in New York. None of the authors accepts any personal compensation from any drug company. Medical writer: Stephen Braun. Copyright 215 by the Alosa Foundation. All rights reserved.
1/4/18. 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: PHARMACOTHERAPY UPDATE
HEART FAILURE: PHARMACOTHERAPY UPDATE 3 HEART FAILURE REVIEW 1 5.1 million x1.25 = 6.375 million 40 years old = MICHAEL F. AKERS, PHARM.D. CLINICAL PHARMACIST CENTRACARE HEALTH, ST. CLOUD HOSPITAL HF Diagnosis
More informationWhat s at the Heart of the Matter?
What s at the Heart of the Matter? Inpatient Pharmacy Services for Heart Failure Patients Jason Williamson, PharmD, BCPS Clinical Pharmacy Manager, PGY1 Pharmacy Residency Director Genesys Regional Medical
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 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 informationNeprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary
Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1 Indication Entresto Reduce the risk of cardiovascular (sacubitril/valsartan) death
More 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 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 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 informationModule 1: Evidence-based Education for Health Care Professionals
Module 1: Evidence-based Education for Health Care Professionals Heart Failure is a HUGE Problem Prevalence Incidence Mortality Hospital Discharges Cost 1 5,300,000 660,000 284,965 1,084,000 $34.8 billion
More informationModule 1: Evidence-based Education for Health Care Professionals
Module 1: Evidence-based Education for Health Care Professionals Heart Failure is a HUGE Problem Prevalence Incidence Mortality Hospital Discharges Cost 1 5,300,000 660,000 284,965 1,084,000 $34.8 billion
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 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 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 informationDisclosures. This speaker has indicated there are no relevant financial relationships to be disclosed.
Disclosures This speaker has indicated there are no relevant financial relationships to be disclosed. And the Beat Goes On: New Medications for Heart Failure Alison M. Walton, PharmD, BCPS The Case of
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 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 informationContemporary Advanced Heart Failure Therapy
Contemporary Advanced Heart Failure Therapy Andrew Boyle, MD Professor of Medicine Medical Director of Advanced Heart Failure Thomas Jefferson University Philadelphia, PA Audience Response Question 40
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 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 informationDon t let the pressure get to you:
Balanced information for better care Don t let the pressure get to you: An update on the changing recommendations for treating hypertension New trial data and guidelines have made hypertension care more
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 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 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 informationDon t let the pressure get to you:
Balanced information for better care Don t let the pressure get to you: Current evidence-based goals for treating hypertension A cornerstone of primary care: Lowering high blood pressure prevents cardiovascular
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 informationNew Winners in the World of Heart Failure. Laura Steffens PharmD Candidate 2016 CICU Presentation August 12, 2015
New Winners in the World of Heart Failure Laura Steffens PharmD Candidate 2016 CICU Presentation August 12, 2015 Jessup 2014 Shaking Things Up 2003: FDA approved eplerenone for the treatment of heart failure
More informationRate of Heart failure guideline adherence in a tertiary care center in India after accounting for the therapeutic contraindications.
Article ID: WMC004618 ISSN 2046-1690 Rate of Heart failure guideline adherence in a tertiary care center in India after accounting for the therapeutic contraindications. Peer review status: No Corresponding
More informationHEART FAILURE KEEPING YOUR PATIENT AT HOME
HEART FAILURE KEEPING YOUR PATIENT AT HOME SUZANNE FRAZIER MS, CRNP, NP-C, CHFN HEART FAILURE DISEASE MANAGEMENT COORDINATOR PENN STATE HERSHEY HEART & VASCULAR INSTITUTE IMPACT OF HEART FAILURE In 2010,
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 informationClinical Pearls Heart Failure Cardiology/New Drugs
Clinical Pearls Heart Failure Cardiology/New Drugs Friday, September 9 th, 2016 Heidi Burres, PharmD, BCACP MTM Pharmacist Fairview Pharmacy Services Thank You to XYZ Event Sponsor(s): Wi-fi Information:
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 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 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 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 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 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 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 informationTreating HF Patients with ARNI s Why, When and How?
Treating HF Patients with ARNI s Why, When and How? 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La Jolla, CA Barry Greenberg M.D. Distinguished Professor
More 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 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 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 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 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 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 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 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 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 informationI know the trials in heart failure but how do I manage my patient? Dosing of neurohormones antagonists
I know the trials in heart failure but how do I manage my patient? Dosing of neurohormones antagonists Alessandro Fucili (Ferrara, IT) Massimo F Piepoli (Piacenza, IT) Clinical Case: 82 year old woman
More 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 informationCodes for a Medicare claims-based model to predict LVEF class- User Guide
Description and citation: This guide accompanies our manuscript [Desai RJ, Lin KJ, Patorno E, et al. Development and Preliminary Validation of a Medicare Claims Based Model to Predict Left Ventricular
More informationEpidemiology of Symptomatic Heart Failure in the U.S.
William T. Abraham, MD, FACP, FACC, FAHA, FESC Professor of Medicine, Physiology, and Cell Biology Director, Division of Cardiovascular Medicine Deputy Director Davis Heart and Lung Research Institute
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 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. 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 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 Background, recognition, diagnosis and management
Heart Failure Background, recognition, diagnosis and management Speaker bureau: Novartis At the conclusion of this activity, participants will be able to: Recognize signs and symptoms of heart failure
More informationHeart Failure A Team Approach Background, recognition, diagnosis and management
Heart Failure A Team Approach Background, recognition, diagnosis and management Speaker bureau: Novartis At the conclusion of this activity, participants will be able to: Recognize signs and symptoms of
More informationHeart Failure (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis. More malignant than most cancers
Patients in US (millions) Heart Failure (HF): Scope of the Problem 1 4 2 3.5 4. 1. 1991 21 237 US prevalence*: 5. million US annual incidence: 7, Annual mortality: 22,754 5-1% depending on severity Cost:
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 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 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 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 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 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: 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 informationSystolic Dysfunction Clinical /Hemodynamic Guide for Management From Neprilysin Inhibitors to Ivabradine
Systolic Dysfunction Clinical /Hemodynamic Guide for Management From Neprilysin Inhibitors to Ivabradine Donna Mancini MD Choudhrie Professor of Cardiology Columbia University Speaker Disclosure Amgen
More 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 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 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 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 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 informationHeart Failure Management: Continuum of Care
Healthy Kingsport Conference Heart Failure Management: Continuum of Care Robin Harris PhD, ANP-BC, ACNS-BC Clinical Assistant Professor University of Tennessee College of Nursing Important Info I, Robin
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Neprilysin Inhibitor (Entresto ) Page 1 of 6 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Neprilysin Inhibitor (Entresto ) Prime Therapeutics will review Prior
More informationCardiovascular Guideline-Driven Pharmacotherapies: Optimizing Management
Cardiovascular Guideline-Driven Pharmacotherapies: Optimizing Management David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management
More informationSystolic Dysfunction Clinical/Hemodynamic Guide for Management; New Medical and Interventional Therapeutic Challenges
Systolic Dysfunction Clinical/Hemodynamic Guide for Management; New Medical and Interventional Therapeutic Challenges Clyde W. Yancy, MD, MSc, FACC, FAHA, MACP Magerstadt Professor of Medicine Professor,
More 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 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 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 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 information12.5mg, 25mg, 50mg. 25mg, 50mg. 2.5mg, 5mg, 10mg. 5mg, 10mg, 20mg, 100mg. 25mg. -- $2.81 Acetazolamide (IR, 125mg, 250mg, 500mg (ER)
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Blood Pressure P&T DATE: 5/9/2017 THERAPEUTIC CLASS: Cardiovascular Disorders REVIEW HISTORY: 9/15, 2/13, 2/08, 5/07 LOB
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 informationObjectives. Heart failure and Hypertension. Definition & epidemiology of heart failure HEART FAILURE 3/12/2016. Kirsten Bibbins-Domingo, PhD, MD, MAS
Objectives Heart failure and Hypertension Kirsten Bibbins-Domingo, PhD, MD, MAS Lee Goldman, MD Endowed Chair in Medicine Professor of Medicine and of Epidemiology and Biostatistics University of California,
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 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 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 informationBackground: Patient Adherence Challenges/Barriers
This Nurse Tip Sheet was developed by AAHFN as resource in facilitating patient education. It provides additional information so that the Nurse can supplement patient teaching with the corresponding Patient
More informationInitiating New Medications in the Management of Heart Failure
Initiating New Medications in the Management of Heart Failure Sandra Oliver-McNeil DNP, MSN, ACNP-BC, CHFN Associate Professor (Clinical) Wayne State University College of Nursing Objectives The participant
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 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 informationHeart Failure (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis. More malignant than cancer
Patients in US (millions) Heart Failure (HF): Scope of the Problem 1 8 6 4 2 3.5 4.8 1. 1991 21 237 US prevalence*: 5.8 million US annual incidence: 67, Annual mortality: 282,754 5-1% depending on severity
More informationGerasimos Filippatos MD, FESC, FCCP, FACC
Gerasimos Filippatos MD, FESC, FCCP, FACC Head of HF Unit at Athens University Hospital, Greece President (2014-2016) of the HF Association of the European Society of Cardiology (ESC) Served as Chair of
More 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 (HF): Scope of the Problem. Temporal Trends in Age-Adjusted Survival After HF Diagnosis. More malignant than most cancers
Evidence-Based Approaches to the Management of Heart Failure: Reducing Hospitalization and Improving Patient Outcomes Eldrin F. Lewis, MD, MPH Director of Cardiovascular Clerkship Brigham and Women s Hospital
More informationRecently, much effort has been put into research. Advances in... Congestive Heart Failure Care. How is CHF diagnosed? 2.
Advances in... Congestive Heart Failure Care Heart failure can currently be considered an epidemic. The article discusses some of the recent advances in outpatient management of congestive heart failure.
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 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 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 informationManagement of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
More information