Recognizing and Treating Patients with the Cardio-Renal Syndrome
|
|
- Julia Parrish
- 5 years ago
- Views:
Transcription
1 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
2 Conflicts of Interest None. 2
3 Outline Why is creatinine often already elevated at presentation in acute decompensated heart failure (ADHF)? On balance, are treatments that improve ADHF but worsen renal function good or bad? Not all worsening renal function is the same. My internist / nephrologist approach to treating ADHF. 3
4 Outline Why is creatinine often already elevated at presentation in acute decompensated heart failure (ADHF)? On balance, are treatments that improve ADHF but worsen renal function good or bad? Not all worsening renal function is the same. My internist / nephrologist approach to treating ADHF. 4
5 Traditional Paradigm for Heart Failure-Induced Worsening Renal Function (WRF) Cardiac output Renal perfusion Renal function Low forward flow 5
6 No Association Between Tertiles of Cardiac Index and egfr, BUN, BUN/Creat, SCr in ADHF 6 Hanberg, JS, et al. JACC 2016;67:2199
7 No Correlation Between Cardiac Index and Change in egfr During Hospitalization with ADHF CI at Baseline Final CI CI on Optimal Day CI Change from Baseline to Final 7 Hanberg, JS, et al. JACC 2016;67:2199
8 Traditional Paradigm for Heart Failure-Induced Worsening Renal Function (WRF) Cardiac output Renal perfusion Renal function Low forward flow 8
9 Change in Intra-Abdominal Pressure is Tightly Correlated with Change in Kidney Function 40 consecutive patients with ADHF 24 of 40 (60%) had intra-abdominal pressure (IAP) > 8mmHg. None had abdominal symptoms. The IAP at admission was correlated with admission Cr. IAP was strongly correlated with serum Cr during the ADHF admission. Cardiac index and PCWP was not different between those with vs. without elevated IAP on admission. 9 Mullens W, et al. JACC 2008; 51:
10 Venous Congestion as a Contributor to Worsening Renal Function (WRF) in Acute Decompensated Heart Failure Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) RCT of 433 patients WRF defined as 20% decline in egfr CVP Cardiac Index These data put venous congestion as a potential central causative factor of WRF in ADHF, and suggest that aggressive treatment of congestion may be a central tenant for treatment ADHF 10
11 Outline Why is creatinine often already elevated at presentation in acute decompensated heart failure (ADHF)? On balance, are treatments that improve ADHF but worsen renal function good or bad? Not all worsening renal function is the same. My internist / nephrologist approach to treating ADHF. 11
12 Lower egfr at baseline is common, and strongly associated with poor outcomes in ADHF Decompensated HF, N=118, Hillege et al, Circulation 2000;102:203
13 Renal Dysfunction Outperforms Traditional Metrics of Disease Severity for Strength of Association with Mortality Renal These data look at CKD at baseline, and reflect Function the severity of the patient s condition. (egfr) The effects of ADHF treatment on kidney function may be very different. Ejection Fraction 13 Hillege et al, Circulation 2000;102:203
14 Studied 366 patients with ADHF from the ESCAPE trial who had baseline and discharge pairs of hematocrit, serum albumin, and total protein data. Change in each of these 3 parameters during admission were categorized into tertiles. Hemoconcentration was defined as having 2 of the 3 parameters in the highest tertile. Examined diuretic response, hemodynamic parameters, and survival by hemoconcentration. 14 Testani JM, et al., Circulation 2010; 122:
15 Effects of Treatment for Congestion on Renal Function and Survival No Hemoconcentration (n=102) Hemoconcentration (n=49) P-value Loop diuretic dose 240 (100, 400) 360 (200, 480) 0.03 Weight (kg) 2.7 ± ± 6.6 < Rate of wt. loss 0.45 ± ± 0.98 < Net fluid loss -3.8 ± ± Rate fluid loss ± ± Testani JM, et al., Circulation 2010; 122:
16 Effects of Treatment for Congestion on Renal Function and Survival Association of Hemoconcentration with Association of Hemoconcentration with Risk Odds of Worsened Renal Function of Survival at 180 Days ( 20% decline in egfr during admission) HR 0.31(0.06, 0.74) p=0.016 OR 5.3 (2.4, 11.7) p< Testani JM, et al., Circulation 2010; 122:
17 The Clinical Significance of Change in egfr Differs if it Reflects Initiation of an ACE-Inhibitor Investigators conducted post-hoc analysis of the SOLVD Trial 6337 patients with EF < 35%, Cr 2.5 mg/dl at entry, randomized to enalapril vs. placebo. Worse renal function (WRF) defined as 20% decrease in egfr from BL to day 14. Prior analyses had already demonstrated that both egfr at baseline and WRF were strongly associated with death. The focus of this analysis was to evaluate if WRF had similar clinical implications in the enalapril vs. placebo group. 17 Testani JM, et al., Circ. Heart Fail. 2011; 4:
18 The Clinical Significance of Change in egfr Differs if it Reflects Initiation of an ACE-Inhibitor Placebo (282 / 3199) Enalapril (324 / 3178) HR (95% CI) for Risk of Death* P interaction *Adjusted for age, race, EF, heart rate, DBP, NYHA class, serum Na, baseline egfr, diabetes, HTN, stroke, MI, loop diuretic use, K sparing diuretic use, digoxin use, and beta blocker use. 18 Testani JM, et al., Circ. Heart Fail. 2011; 4:
19 The Clinical Significance of Change in egfr Differs if it Reflects Initiation of an ACE-Inhibitor HR (95% CI) for Risk of Death* Placebo (282 / 3199) 1.4 (1.1, 1.8) p< 0.01 Enalapril (324 / 3178) P interaction *Adjusted for age, race, EF, heart rate, DBP, NYHA class, serum Na, baseline egfr, diabetes, HTN, stroke, MI, loop diuretic use, K sparing diuretic use, digoxin use, and beta blocker use. 19 Testani JM, et al., Circ. Heart Fail. 2011; 4:
20 The Clinical Significance of Change in egfr Differs if it Reflects Initiation of an ACE-Inhibitor HR (95% CI) for Risk of Death* Placebo (282 / 3199) 1.4 (1.1, 1.8) p< 0.01 Enalapril (324 / 3178) 1.0 (0.8, 1.3) p=1.00 P interaction *Adjusted for age, race, EF, heart rate, DBP, NYHA class, serum Na, baseline egfr, diabetes, HTN, stroke, MI, loop diuretic use, K sparing diuretic use, digoxin use, and beta blocker use. 20 Testani JM, et al., Circ. Heart Fail. 2011; 4:
21 The Clinical Significance of Change in egfr Differs if it Reflects Initiation of an ACE-Inhibitor HR (95% CI) for Risk of Death* Placebo (282 / 3199) 1.4 (1.1, 1.8) p< 0.01 Enalapril (324 / 3178) 1.0 (0.8, 1.3) p=1.00 P interaction 0.04 *Adjusted for age, race, EF, heart rate, DBP, NYHA class, serum Na, baseline egfr, diabetes, HTN, stroke, MI, loop diuretic use, K sparing diuretic use, digoxin use, and beta blocker use. 21 Testani JM, et al., Circ. Heart Fail. 2011; 4:
22 The Clinical Significance of Change in egfr Differs if it Reflects Initiation of an ACE-Inhibitor HR (95% CI) for Risk of Death* Placebo (282 / 3199) 1.4 (1.1, 1.8) p< 0.01 Enalapril (324 / 3178) 1.0 (0.8, 1.3) p=1.00 P interaction 0.04 *Adjusted for age, race, EF, heart rate, DBP, NYHA class, serum Na, baseline egfr, diabetes, HTN, stroke, MI, loop diuretic use, K sparing diuretic use, digoxin use, and beta blocker use. 22 Testani JM, et al., Circ. Heart Fail. 2011; 4:
23 Acute Rise in Serum Creatinine During Acute Heart Failure Good thing Induced loss of egfr Bad thing Spontaneous loss of egfr Diuresis in HF Decongestion Hemoconcentration RAAS antagonism Untreated cardiorenal Sepsis Nephrotoxins 23 Outcomes Better Outcomes Worse
24 Outline Why does creatinine often already up at presentation of acute decompensated heart failure (ADHF)? On balance, are treatments that improve ADHF but worsen renal function good or bad? Not all worsening renal function is the same. My internist / nephrologist approach to treating ADHF. 24
25 If Treating Congestion is Good, then what about Ultrafiltration? 25
26 Costanzo et al. JACC 2007 UNLOAD Trial 200 inpatients with ADHF, randomized to UF vs IV diuretic (2X pre-hospital dose) More weight loss with UF Less rehospitalizations with UF 26
27 CARESS-HF Required WRF as an inclusion criteria ( 0.3 mg/dl in last 12 weeks). Fixed UF rate (-200cc/hr for everyone regardless of hemodynamics) Used a more aggressive diuretic protocol. 46% received metolazone within first 7 days Only 6% needed UF for lack of response 27 Bart BA, et al. NEJM 2012;367:2296
28 CARRESS-HF: Equal Amount of Weight Loss; Creatinine Higher in UF Arm 28 Bart BA, et al. NEJM 2012;367:2296
29 CARESS-HF 29 Bart BA, et al. NEJM 2012;367:2296
30 Not all worsening renal failure in treatment of ADHF is the same ADHF Venous Congestion Low SBP Low CI High Ang. II Worse Renal Function ~ 90% ~ 10% Diuresis Hemoconcentration Afterload reduction ACE inhibition
31 Not all worsening renal failure in treatment of ADHF is the same. Acute Tubule Necrosis (ATN) 31
32 Outline Why does creatinine often already up at presentation of acute decompensated heart failure (ADHF)? On balance, are treatments that improve ADHF but worsen renal function good or bad? Not all worsening renal function is the same. My internist / nephrologist approach to treating ADHF. 32
33 My Approach To Treatment of ADHF with Renal Dysfunction Stable or Improved Renal Function (in 60-80%) ADHF/ Congestion This has to be treated! 33 Give high-dose loop diuretic (2.5x) Add metolazone to block DCT Worsened renal function (in 20-40%) Still congested Some worsening in egfr but decongested (20-30% decline) Deal with it Call your Renal friends Renal function keeps worsening
34 My Advice for Avoiding Acute Tubule Necrosis Understand the need to be aggressive in treating congestion: Don t let CKD or modest WRF stop your patient from getting adequate diuresis or ACE inhibition. Don t be too eager to discharge and hope for additional improvements in clinical stats as an out-patient. Adding treatments may take a step approach when Cr has been steady for a few days before adding on additional therapies. 34
35 My Advice for Avoiding Acute Tubule Necrosis Understand that ADHF are at high risk for ATN Poor renal perfusion ACE inhibition further decreases GFR BP often low. 35
36 My Advice for Avoiding Acute Tubule Necrosis Recognize that any additional insults are very likely to cause ATN Avoid NSAIDs. Think and rethink need for radiocontrast, especially in diabetic patients. If contrast is needed, consider holding ACE and diuretics for 48 hours before and after. 36
37 My Advice for Avoiding Acute Tubule Necrosis Dialysis or ultrafiltration may be needed. But we lose the ability to manage momentary changes in venous filling, and ATN risk may be particularly high. It may be needed, but should be treatment of last resort. 37
38 Thank you Pranav Garimella, MD, MS Assistant Professor Division of Nephrology-Hypertension UC San Diego Steven Coca, MD Associate Professor Division of Nephrology Icahn School of Medicine at Mount Sinai All of you for your attention an interest 38
Pivotal 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 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 informationCardiorenal syndrome. Sofie Gevaert. Ghent University Hospital, Belgium
Cardiorenal syndrome Sofie Gevaert Ghent University Hospital, Belgium Disclosures Consultancy Astra Zeneca Boegringer MSD Novartis 68 y old man, ADHF ICMP, ejection fraction 35 %: progressive dyspnea,
More informationOvercoming the Cardiorenal Syndrome
Overcoming the Cardiorenal Syndrome October 29, 2016 Randall C Starling MD MPH FACC FESC FHFSA FHFA Professor of Medicine Heart & Vascular Institute Cleveland Clinic Lerner College of Medicine Cleveland
More informationCase Presentation. This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
Worsening Renal Function in Heart Failure Patients Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center
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 informationThe Cardiorenal Syndrome in Heart Failure
The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October 9, 2015 Disclosures None 1 Cardiorenal Syndrome (CRS) A pathophysiologic
More informationCardio-Renal Syndrome in Acute Heart Failure:
Cardio-Renal Syndrome in Acute Heart Failure: Target for Therapy Marvin A. Konstam, M.D. Research support and/or consulting relevant to this lecture: Merck, Otsuka, Johnson & Johnson; Amgen; Cardiokine
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 informationWORSENING OF RENAL FUNCTION AFTER RAS INHIBITION IN DECOMPENSATED HEART FAILURE: CLINICAL IMPLICATIONS
WORSENING OF RENAL FUNCTION AFTER RAS INHIBITION IN DECOMPENSATED HEART FAILURE: CLINICAL IMPLICATIONS George Bakris, MD, FASH, FAHA, FASN Professor of Medicine Director, Comprehensive Hypertension Center
More informationHeart Failure and Renal Failure. Gerasimos Filippatos, MD, FESC, FHFA President HFA
Heart Failure and Renal Failure Gerasimos Filippatos, MD, FESC, FHFA President HFA Definition Epidemiology Pathophysiology Management (?) Recommendations for NHLBI in cardiorenal interactions related to
More informationCardiorenal Syndrome
SOCIEDAD ARGENTINA DE CARDIOLOGIA Cardiorenal Syndrome Joint session ESC-SAC ESC Congress 2012, Munich César A. Belziti Hospital Italiano de Buenos Aires I have no conflicts of interest to declare Cardiorenal
More informationTHE KIDNEY IN HYPOTENSIVE STATES. Benita S. Padilla, M.D.
THE KIDNEY IN HYPOTENSIVE STATES Benita S. Padilla, M.D. Objectives To discuss what happens when the kidney encounters low perfusion To discuss new developments and clinical application points in two scenarios
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 informationDefining and Managing the Cardiorenal Syndrome in Acute Decompensated Heart Failure. Barry M. Massie Professor of Medicine UCSF
Defining and Managing the Cardiorenal Syndrome in Acute Decompensated Heart Failure Barry M. Massie Professor of Medicine UCSF DISCLOSURES Consulting fees: Merck-Novacardia Novartis Bristol Myers Squibb
More informationMonitoring of Renal Function in Heart Failure
Monitoring of Renal Function in Heart Failure Adriaan A. Voors, cardiologist The Netherlands Disclosures AAV received consultancy fees and/or research grants from: Alere, Bayer, Cardio3Biosciences, Celladon,
More informationThe Art and Science of Diuretic therapy
The Art and Science of Diuretic therapy Dr. Fayez EL Shaer Associate Professour of cardiology Consultant cardiologist MD, MSc, PhD, CBNC, NBE FESC, ACCP, FASNC,HFA KKUH, KFCC Heart failure: fluid overload
More informationA patient with acute heart failure and renal impairment ACCA Masterclass 2017
A patient with acute heart failure and renal impairment Dr Sofie Gevaert Mister P. J.M., 67-years-old Cardiac risk factors: Ex-smoker, AHT, Type 2 diabetes, BMI 43, Hyperlipidaemia Medical history: 2009:
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 informationEffects of Kidney Disease on Cardiovascular Morbidity and Mortality
Effects of Kidney Disease on Cardiovascular Morbidity and Mortality Joachim H. Ix, MD, MAS Assistant Professor in Residence Division of Nephrology University of California San Diego, and Veterans Affairs
More informationObjectives 6/14/2016. Cardiorenal Syndrome: Critical Link Between Heart and Kidney
Cardiorenal Syndrome: Critical Link Between Heart and Kidney Chris M. Bell, ACNP Cardiology Associates of North Mississippi Objectives Review the 5 Subtypes of the Cardiorenal Syndrome (CRS) Discuss the
More informationJournal Club PowerPoint Template. A Question of Therapy RCT
Journal Club PowerPoint Template A Question of Therapy RCT 1 EBM Process Ask a well built (focused) clinical question Search for the best evidence to answer the question Critically appraise the evidence
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 informationState-of-the-Art: Treatment of Renal Dysfunction in Heart Failure. W. H. Wilson Tang, MD Cleveland Clinic, U.S.A.
State-of-the-Art: Treatment of Renal Dysfunction in Heart Failure W. H. Wilson Tang, MD Cleveland Clinic, U.S.A. Heart Failure Exacerbates Renal Insufficiency ADHERE Registry: Prevalence of CKD by egfr
More informationThe Triple Threat. Cardiac Care in the NT Annual Workshop 2017 is proudly supported by:
The Triple Threat DR KELUM PRIYADARSHANA FRACP CONSULTANT NEPHROLOGIST ROYAL DARWIN HOSPITAL Cardiac Care in the NT Annual Workshop 2017 is proudly supported by: Pathogenesis Diabetes CKD CVD Diabetic
More informationMedical Management of Acutely Decompensated Heart Failure. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Medical Management of Acutely Decompensated Heart Failure William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Goals of Acute Heart Failure Therapy Alleviate
More informationAcute Kidney Injury in the Hospitalized Patient
Acute Kidney Injury in the Hospitalized Patient Biff F. Palmer, M.D. Professor of Internal Medicine University of Texas Southwestern Medical Center, Dallas Texas Classification of Acute Kidney Injury 1
More informationCardiorenal Syndrome
Cardiorenal Syndrome Peenida Skulratanasak, M.D. Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University Definition of Cardiorenal syndrome (CRS) Structural
More informationHeart-failure or Kidney Failure?
Heart-failure or Kidney Failure? Dr Ajith James Consultant Nephrologist Barts Health and BHRUT Mr AR 65 yrs Case Type 2 DM, IHD-MI 1998, 2003. PCI x 3. CABG 2008, HT CCF with LVEF 30% 2014. NYHA Class
More informationBiomarkers, the Kidney and the Heart: Acute Kidney Injury
Biomarkers, the Kidney and the Heart: Acute Kidney Injury 12th Annual Conference on Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices San Diego May 13, 2016 Ravindra
More informationUsing Lung Ultrasound to Diagnose and Manage Acute Heart Failure
Using Lung Ultrasound to Diagnose and Manage Acute Heart Failure Jennifer Martindale, MD Assistant Professor Department of Emergency Medicine SUNY Downstate/Kings County Hospital Brooklyn, NY What is acute
More informationMedical Management of Acute Heart Failure
Critical Care Medicine and Trauma Medical Management of Acute Heart Failure Mary O. Gray, MD, FAHA Associate Professor of Medicine University of California, San Francisco Staff Cardiologist and Training
More informationState of the Art: acute heart failure Is it just congestion?
ESC CONGRESS 2017 Barcelona, 26. 30. August 2017 State of the Art: acute heart failure Is it just congestion? S.B. Felix, FESC Klinik für Innere Medizin B Ernst-Moritz-Arndt-Universität Greifswald 1456
More informationCardiorenal Syndrome Prof. Dr. Bülent ALTUN Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Nephrology
Cardiorenal Syndrome Prof. Dr. Bülent ALTUN Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Nephrology Heart and Kidney The kidney yin dominates water, The heart yang
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 informationJNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults
JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation
More informationHeart failure: what should be changed? Prof. Gerasimos Filippatos Attikon University Hospital
Heart failure: what should be changed? Prof. Gerasimos Filippatos Attikon University Hospital Disclosures Chair or Committee Member of trials or registries sponsored by Novartis, Bayer, Cardiorentis, Servier
More informationSystolic Blood Pressure Intervention Trial (SPRINT)
09:30-09:50 2016.4.15 Systolic Blood Pressure Intervention Trial (SPRINT) IN A NEPHROLOGIST S VIEW Sejoong Kim Seoul National University Bundang Hospital Current guidelines for BP control Lowering BP
More informationTreating Hypertension in 2018: What Makes the Most Sense Today?
Treating Hypertension in 2018: What Makes the Most Sense Today? Daniel Blanchard, MD Professor of Medicine UC San Diego Cardiovascular Center La Jolla, California 1 2 Speaker Disclosures Consultant and/or
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 informationSlide 1. Slide 2. Slide 3. Managing Acute Heart Failure Trials and Tribulations. Declaration of
Slide 1 Managing Acute Heart Failure Trials and Tribulations Martin R Cowie MD MSc FRCP FRCP (Ed) FESC Professor of Cardiology, Imperial College London m.cowie@imperial.ac.uk @ProfMartinCowie Slide 2 Declaration
More informationMetabolic Syndrome and Chronic Kidney Disease
Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference
More informationHEART FAILURE IN WOMEN. Marian Limacher, MD Division of Cardiovascular Medicine University of Florida
HEART FAILURE IN WOMEN Marian Limacher, MD Division of Cardiovascular Medicine University of Florida Outline Epidemiology Clinical Overview Why HF is such a challenge State of the Field Heart Failure Adjudication
More 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 informationG. Allen Bryant III, M.D.,F.A.S.N Director Medical Subspecialties LMH Co-Director Renal Services LMH LMPC Chairman of Board
G. Allen Bryant III, M.D.,F.A.S.N Director Medical Subspecialties LMH Co-Director Renal Services LMH LMPC Chairman of Board Presentation Outline/Goals Convince you that having combined LV dysfunction and
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 informationLife After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention
Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention No Relationships to Disclose The Need for Modern Renal Trials Increased rate of RAS diagnosis
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 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 informationImpact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction
Impact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction Masahito Shigekiyo, Kenji Harada, Ayumi Okada, Naho Terada, Hiroyoshi Yoshikawa, Akira Hirono,
More informationUltrafiltration in Decompensated Heart Failure. Description
Subject: Ultrafiltration in Decompensated Heart Failure Page: 1 of 7 Last Review Status/Date: September 2016 Ultrafiltration in Decompensated Heart Failure Description Ultrafiltration is a technique being
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 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 informationLXIV: DRUGS: 4. RAS BLOCKADE
LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations
More informationUnderstanding the Cardio-Renal Syndromes
Understanding the Cardio-Renal Syndromes The Cardio-Renal axis: an underestimated player in cardiovascular diseases ESC Congress Munich 27/08/2012 Alberto Palazzuoli Department of Internal Medicine Cardiology
More informationHeart Failure and Cardio-Renal Syndrome 1: Pathophysiology. Biomarkers of Renal Injury and Dysfunction
CRRT 2011 San Diego, CA 22-25 February 2011 Heart Failure and Cardio-Renal Syndrome 1: Pathophysiology Biomarkers of Renal Injury and Dysfunction Dinna Cruz, M.D., M.P.H. Department of Nephrology San Bortolo
More informationCardiorenal Biomarkers and Heart Failure. Nicholas Wettersten, MD April 7 th, 2017
Cardiorenal Biomarkers and Heart Failure Nicholas Wettersten, MD April 7 th, 2017 Disclosures Still none, but looking for some Acute Kidney Injury Biomarkers 547 in 2015 4112 as of March 2017 Case 1 60
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 informationThe right heart: the Cinderella of heart failure
The right heart: the Cinderella of heart failure Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland none Disclosure Look into the Heart
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 informationCardiorenal and Renocardiac Syndrome
And Renocardiac Syndrome A Vicious Cycle Cardiorenal and Renocardiac Syndrome Type 1 (acute) Acute HF results in acute kidney injury Type 2 Chronic cardiac dysfunction (eg, chronic HF) causes progressive
More informationACUTE KIDNEY INJURY. Stuart Linas U. Colorado SOM
ACUTE KIDNEY INJURY Stuart Linas U. Colorado SOM Marked increases in incidence of dialysis-requiring AKI in last decade JASN 24 37 2013 Question 1 Of patients who recover from an episode of AKI, what percentage
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 informationPreventing and Treating High Blood Pressure
Preventing and Treating High Blood Pressure: Finding the Right Balance of Integrative and Pharmacologic Approaches Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Blood Pressure
More informationHypertension Update Clinical Controversies Regarding Age and Race
Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT
More informationHyponatremia as a Cardiovascular Biomarker
Hyponatremia as a Cardiovascular Biomarker Uri Elkayam, MD Professor of Medicine University of Southern California Keck School of Medicine elkayam@usc.edu Disclosure Research grant from Otsuka for the
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 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 informationDiastolic Heart Failure Uri Elkayam, MD
Diastolic Heart Failure Uri Elkayam, MD Professor of Medicine University of Southern California School of Medicine Los Angeles, California elkayam@usc.edu Diastolic Heart Failure Clinical Definition A
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 informationOptimal blockade of the Renin- Angiotensin-Aldosterone. in chronic heart failure
Optimal blockade of the Renin- Angiotensin-Aldosterone Aldosterone- (RAA)-System in chronic heart failure Jan Östergren Department of Medicine Karolinska University Hospital Stockholm, Sweden Key Issues
More informationBeyond ACE-inhibitors for Heart Failure. Jacob Townsend, MD NCVH Birmingham 2015
Beyond ACE-inhibitors for Heart Failure Jacob Townsend, MD NCVH Birmingham 2015 % Decrease in Mortality Current Therapy HFrEF 0% Angiotensin receptor blocker ACE inhibitor Beta blocker Mineralocorticoid
More informationOutline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan
New Pharmacological Therapies for Heart Failure Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center
More 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 informationCardio-renal syndrome.
Review Article Cardio-renal syndrome. http://www.alliedacademies.org/archives-of-general-internal-medicine/ ISSN: 2591-7951 Dhiraj Kumar*, Abhijeet Yelale, Girish Sabnis, Hetan Shah, Charan Lanjewar, Prafulla
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More informationHow to define the target population?
Heart Failure 2011 22-24 May. Gothenburg, Sweden Mortality or morbidity as target in acute heart failure trials How to define the target population? Marco Metra, Brescia The Burden of Acute HF Acute HF
More informationHeart Failure Dr Eric Klug Sunninghill, Sunward Park, CM Johannesburg Academic Hospital
Heart Failure 2012 Dr Eric Klug Sunninghill, Sunward Park, CM Johannesburg Academic Hospital PRELOAD COWS Reduction in milk production INOTROPY & HEART RATE AFTERLOAD DISTRIBUTION NETWORK THE CLASSIC APPROACH
More informationAldosterone Antagonism in Heart Failure: Now for all Patients?
Aldosterone Antagonism in Heart Failure: Now for all Patients? Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine, University of Minnesota, Director Heart Failure Program, VA Medical Center 111C
More 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 informationST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective
ST2 as a Cardiovascular Biomarker Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Coronary Care Unit University of California, San Diego ST2 and IL-33: Cardioprotective ST2: member of the
More informationegfr > 50 (n = 13,916)
Saxagliptin and Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus and Moderate or Severe Renal Impairment: Observations from the SAVOR-TIMI 53 Trial Supplementary Table 1. Characteristics according
More informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More informationImplementing the CardioMEMS HF System into the Management of Heart Failure Patients
Implementing the CardioMEMS HF System into the Management of Heart Failure Patients Robert W. Hull MD FACC Associate Professor of Medicine WVU Heart Institute Co-director, Arrhythmia Service Director,
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 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 informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Ultrafiltration in Heart Failure Page 1 of 8 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Ultrafiltration in Heart Failure Professional Institutional Original
More informationModern Management of Hypertension: Where Do We Draw the Line?
Modern Management of Hypertension: Where Do We Draw the Line? Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Blood Pressure
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%
More informationSUPPLEMENTAL MATERIAL
SUPPLEMENTAL MATERIAL Table S1: Number and percentage of patients by age category Distribution of age Age
More informationFluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
More informationRRT in Advanced Heart Failure and Liver Failure When to start and when to stop?
Critical Care Medicine Apollo Hospitals RRT in Advanced Heart Failure and Liver Failure When to start and when to stop? Ramesh Venkataraman, AB (Int. Med), AB (CCM) Senior Consultant, Critical Care Medicine
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 informationNovel Approaches for Recognition and Management of Life Threatening Complications of AKI and CKD: Focus on Acute Cardiorenal Syndromes
Novel Approaches for Recognition and Management of Life Threatening Complications of AKI and CKD: Focus on Acute Cardiorenal Syndromes Peter A. McCullough, MD, MPH Baylor University Medical Center, Dallas
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,
More informationAcute Kidney Injury in the ED
+ Acute Kidney Injury in the ED + Dr Eric Clark, MD FRCPC University of Ottawa Canada Canadian Association of Emergency Physicians + Outline 1. Diagnostic challenges 2. ED treatment 3. Contrast induced
More informationObjectives. Describe results and implications of recent landmark hypertension trials
Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships
More informationImportance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure
Journal of the American College of Cardiology Vol. 53, No. 7, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.05.068
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 informationBiomarkers for optimal management of heart failure. Cardiorenal syndrome. Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland
Biomarkers for optimal management of heart failure Cardiorenal syndrome Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland Presenter Disclosure Information V-P Harjola The following
More information