Heart Failure Dr Eric Klug Sunninghill, Sunward Park, CM Johannesburg Academic Hospital
|
|
- Madison Owen
- 5 years ago
- Views:
Transcription
1 Heart Failure 2012 Dr Eric Klug Sunninghill, Sunward Park, CM Johannesburg Academic Hospital
2 PRELOAD COWS Reduction in milk production INOTROPY & HEART RATE AFTERLOAD DISTRIBUTION NETWORK
3 THE CLASSIC APPROACH CARDIO-RENAL SYNDROME IN CHF Decreased cardiac performance Decreased cardiac output Increased water & Na + retention Impaired renal function Structural renal changes NATRIURETIC PEPTIDE SYSTEM RAA SYSTEM SYMPATHETIC NERVOUS SYSTEM Neurohormonal activation Diminished blood flow Decreased renal perfusion
4 LV Geometry Renlund D and Kfoury A. N Engl J Med 2006;355:
5 CHF SUCCESS Improvement in LVEF has been reported to be a major predictor of improved survival Am Heart J 2012;163:49-56.e2
6 Drugs Used in Heart Failure Patients Diuretic ACE inhibitor Beta-blocker Aldosterone antagonist Nitrates plus arteriodilator Digitalis Sinus Rate slowing agents Even if these drugs lower blood pressure, they can paradoxically improve cardiac output Angiotensin-receptor blockers Antiarrhythmics Calcium channel blockers Cardiotonic/inotropic agents
7 Maximal treadmill exercise time before and after a diuretic Exercise duration (mins) B A
8 AT REST: PRE AND POST DIURETIC Plasma ALDOSTERONE AFTER EXERCISE: PRE AND POST DIURETIC Plasma ALDOSTERONE
9 Courtesy of the Mary Evans Picture Library DIGITALIS Eichhorn, E. J. et al. N Engl J Med 2002;347:
10 Percent of Patients ACE Inhibitors vs Placebo in Symptomatic CHF: Overview % Risk Reduction P> % Risk Reduction P>0.001 Placebo ACEI % Risk Reduction P> % Risk Reduction P= Total Mortality Garg R, Yusef S. JAMA. 1995;273: Death or CHF Hospitalization CHF Death Fatal MI
11 Mortality According to Adherence Score Drug Adherence Overall >80 <80 Candesartan 23.3% 21.7% 34.1% Placebo 24.9% 23.2% 37.9%
12 The balance in care Cardiologists adhere more closely to evidencebased guidelines Generalists provide more comprehensive care overall, especially to elderly patients with complex co-morbidities Am Heart J 2012;163:252-9
13 HF is such a common problem, it is not possible to have cardiologists involved in the care of all patients; as such improving outcomes in patients with HF treated by generalist physicians is an important objective Am Heart J 2012;163:252-9
14 Non Pharmacologic Management Employment Dietary sodium restriction Restriction of daily fluid intake Obstructive sleep apnoea
15 OSA/CSA 40 50% of CHF patients > 50% are asymptomatic CPAP improves LVEF by 8 10%, with clinical symptom improvement CPAP decreases MR, HR, and afterload Nocturnal oxygen therapy is effective in patients who have CSR/CSA and CHF Respir Care 2006;51(4):
16 NSAIDS: Composite End Point: Death from CVS Causes, MI, CVA, or HF among Patients Who Received Celecoxib (200 mg BD or 400 mg BD) or Placebo.
17 Pulmonary hypertension prognosis in CHF PHT NO PHT Mortality at 28 months (%) 57 17
18 Pulmonary Hypertension Sildenafil can be considered in carefully selected patients with pulmonary hypertension and LVSD CHF CHF and suspected pulmonary vascular remodeling with sustained significant elevations of mpap (mpap >25 mmhg), and/or uncontrolled RV failure after all other conventional strategies have been aggressively exhausted.
19 Nitrate/Hydralazine: Overall Survival 180 days 43% improved survival p=0.01 Taylor, A. et al. N Engl J Med 2004;351:
20 Nitrosative stress Oxidative stress NEJM 351;20
21 Nitrate/Hydralazine in CHF 225 mg Hydralazine 120 mg Isosorbide dinitrate 3 divided doses Starting dose 37.5/20 mg tds, uptitrated rapidly within a week by telephone! Target dose achieved in 68% of I/H group Only 1 patient with lupus-like syndrome Indicated in symptomatic black patients on background chronic anti-failure therapy
22 EMPHASIS-HF NYHA class II 2737 patients Eplerenone or placebo N Engl J Med 2011; 364:11 21.
23 EMPHASIS-HF The number needed to treat to postpone one death per year was 51 and to prevent one primary outcome from occurring was 19 Death from any cause Hospitalization for heart failure or death from cardiovascular causes (%) N Engl J Med 2011; 364:11 21.
24 Side effects of eplerenone compared with placebo N Engl J Med 2011; 364: Which MRA?
25 Diuretic Resistance Present in approximately 25% - 30% of patients with CHF Defined as reduced diuresis and natriuresis in response to a constant high dose of loop diuretics. Circ Heart Fail 2009;2;
26 Kaplan Meier Curves for the Clinical Composite End Point of Death,Rehospitalization, or Emergency Department Visit. Bolus vs Infusion? Low vs High dose?
27 Diuretic synergy
28 Renal dysfunction frequent co-morbidity in CHF 60% % pts CrCL< 60ml/min, independently associated with All cause death Pump failure death HF hospitalisation In real life RD may be more common Patients with severe RD excluded from the trials 62% 40% 20% GFR < 60 21% GFR < 60 36% GFR 58 50% GFR: % GFR: GFR < 45 SOLVD-P NYHA I-II (n=3673) SOLVD-T NYHA II-III (n=2161) PRIME-II NYHA III-IV (n=1702) VALIANT (post AMI, CHF / LVD) (n=14527) Dries et al.; JACC 2000;35:681 Hillege et al., Circulation 2000;102:203 Anavekar et al., N Engl J Med 2004;351:1285
29 Ivabradine SHIFT Inhibit the If current in the sinoatrial node, reducing heart rate NYHA class II or III Mean baseline HR was 80, dropped to 64 at 1 month, 67 after 32 months in the ivabradine group, compared with 75 (P) Lancet 2010;376:
30 Effects of ivabradine versus placebo on primary and major secondary end points Lancet 2010;376: On maximal tolerated beta-blocker, heart rate above 75 beats/min
31 Impact of Mechanical Dyssynchrony MRI-Tagged 3-D Cine-Imaging A Adapted from Kass DA. Rev Cardiovasc Med. 2003;4(suppl 2):S3-S13. Adapted from Leclercq C, et al. Circulation. 2001;106:
32 RV LV
33 CRT -Cardiac Resynchronisation Therapy Over last decade, > 8200 patients have been studied Reduces morbidity and mortality (NYHA) class III and prolonged QRS duration >130 ms, (LBBB) + (LVEF) < 35% Reduces death and hospitalisation (NYHA) class II and wide complex QRS, (LVEF) < 35%
34 ICD: Implantable Cardioverter Defibrillators Lancet 2011; 378:
35 Prevalence of Atrial Fibrillation Increases with Severity of HF Prevalence of atrial fibrillation in clinical studies of CHF CONSENSUS OPTIME CHF GESICA PRIME DIAMOND CHF MERIT HF MERIT HF CIBIS II COMET CHF STAT Val-HeFT I and II DIG OPTIMAAL SOLVD Rx SOLVD Px NYHA I II NYHA II III NYHA III IV NYHA IV Patients with atrial fibrillation (%) Savelieva. Europace 2004;5(Suppl. 1):S5 19
36 Warfarin Patients with heart failure have an increased risk of stroke and of systemic thromboembolic events, which are believed to arise from within the heart May 2, 2012 ( /NEJMe )
37 WARCEF trial Homma S et al. N Engl J Med 2012;366: Cumulative Incidence of the Primary Outcome.
38 WARCEF trial Anticoagulant therapy prevents stroke, probably embolic stroke, in patients with SR and severe systolic dysfunction Rates of stroke are too low to justify the routine clinical use of warfarin in most patients with heart failure, in light of the increase in the risk of bleeding. N Engl J Med 2012; 366:
39 Dabigatran Compared with Warfarin in Patients with Atrial Fibrillation and Symptomatic Heart Failure: A Subgroup Analysis of the RE-LY Trial The overall benefits of dabigatran for stroke/see prevention, major bleeding and ICH events relative to warfarin in the RE-LY trial were essentially unchanged in patients with previous CHF. Volume 124(AHA MeetingAbstracts) Supplement 1, 22 November 2011
40 -Blocker Continuation or Withdrawal J. Am. Coll. Cardiol. 2008;52;
41 The Beta-Blocker and DHF In patients admitted to hospital due to worsening HF, a reduction in the -blocker dose may be necessary. In severe situations, temporary discontinuation can be considered. Low-dose therapy should be re-instituted and up-titrated as soon as the patient s clinical condition permits, preferably prior to discharge. Eur J Heart Failure 2008:10;933
42 Treatment Algorithm Systolic Heart Failure. NEJM 362;3
43
Understanding 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 informationCombination of renin-angiotensinaldosterone. how to choose?
Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants
More 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 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 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 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 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 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 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 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 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 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 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 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 informationCKD Satellite Symposium
CKD Satellite Symposium Recommended Therapy by Heart Failure Stage AHA/ACC Task Force on Practice Guideline 2001 Natural History of Heart Failure Patients surviving % Mechanism of death Sudden death 40%
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 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 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 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 informationWhat s new in heart failure management? Yonsei Cardiovascular Center Yonsei University College of Medicine
What s new in heart failure management? Yonsei Cardiovascular Center Yonsei University College of Medicine Current Guideline of Treatment Asymptomatic Mild/Mod Severe Refractory Correct Cause: Arrhythmias
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 (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 Update John Coyle, M.D.
Heart Failure Update 2011 John Coyle, M.D. Causes of Heart Failure Anderson,B.Am Heart J 1993;126:632-40 It It is now well-established that at least one-half of the patients presenting with symptoms and
More informationheart failure John McMurray University of Glasgow.
A to Z of RAAS blockade in heart failure John McMurray BHF Cardiovascular Research Centre University of Glasgow. RAAS inhibition in CHF ACE inhibition in patients with low LVEF CHF CONSENSUS Enalapril
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 informationThe NEW Heart Failure Guidelines
The NEW Heart Failure Guidelines Daily Practice HF scenario of the Case Presentations HF as a complex and heterogeneous syndrome Several proposed pathophysiological mechanisms involving the heart and the
More informationWhy to use digoxin in heart failure?
Why to use digoxin in heart failure? Yves Juillière, Cardiology, ILCV, CHU Nancy-Brabois, France Digitalis purpurea Representation of the extracellular loops and the transmembrane domain regions of the
More informationFaiez Zannad. Institut Lorrain du Coeur et des Vaisseaux. CIC - Inserm
Faiez Zannad Institut Lorrain du Coeur et des Vaisseaux CIC - Inserm Disclosure Faiez Zannad Grants BG Medicine, Roche Diagnostics. Consultant/Steering committees/event committees/ Data safety Monitoring
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 informationAdvanced Heart Failure Management. Dr Andrew Hannah Consultant Cardiologist Aberdeen Royal Infirmary
Advanced Heart Failure Management Dr Andrew Hannah Consultant Cardiologist Aberdeen Royal Infirmary Grading of heart failure Mr WY age 73 3/12 dyspnoea, fatigue and some ankle oedema PMH: hypertension
More 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 informationChronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update)
Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update) NICE guideline Apendix C The algorithms Draft for consultation, January 2010 Chronic
More 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 informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST TAKE HOME MESSAGES FROM RECENT HEART FAILURE CLINICAL TRIALS How to use aldosterone blockers? Faiez Zannad INSERM, U961 and Clinical Investigation Center CHU, Heart
More informationDrugs acting on the reninangiotensin-aldosterone
Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School
More informationPharmacological Treatment for Chronic Heart Failure. Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014
Pharmacological Treatment for Chronic Heart Failure Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014 1 ACC/AHA 2005 guideline update for Diagnosis & management of CHF in the Adult -SA Hunt
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 informationHeart Failure. Dr. William Vosik. January, 2012
Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment
More 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 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 informationDiagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham
Diagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Chronic heart failure
More information2016 Update to Heart Failure Clinical Practice Guidelines
2016 Update to Heart Failure Clinical Practice Guidelines Mitchell T. Saltzberg, MD, FACC, FAHA, FHFSA Medical Director of Advanced Heart Failure Froedtert & Medical College of Wisconsin Stages, Phenotypes
More informationHFpEF, 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 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 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 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 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 informationUpdate on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy
Update on pharmacological treatment of heart failure Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Presenter Disclosures Dr. Maggioni : Serving in Committees of studies sponsored
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. 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 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 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 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 informationHF and CRT: CRT-P versus CRT-D
HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA
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 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 informationBeta-blockers in heart failure: evidence put into practice
Beta-blockers in heart failure: evidence put into practice John McMurray Professor of Medical Cardiology, University of Glasgow & Consultant Cardiologist,Western Infirmary, Glasgow, UK Eugene Braunwald
More informationAre Drugs Better? Dr Mauro Lencioni. Drugs or ablation as first line treatment for AF? Consultant Cardiologist & Electrophysiologist
Are Drugs Better? Drugs or ablation as first line treatment for AF? Dr Mauro Lencioni Consultant Cardiologist & Electrophysiologist The Philosophical Issue What do we mean by Better? Outcome measures Measurement
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 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 informationESC Guidelines for diagnosis and management of HF 2012: What s new? John Parissis, MD Athens, GR
ESC Guidelines for diagnosis and management of HF 2012: What s new? John Parissis, MD Athens, GR Disclosures ALARM INVESTIGATOR RESEARCH GRANTS BY ABBOTT USA AND ORION PHARMA The principal changes from
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 informationUpdates in Heart Failure (HF) 2016: ACC / AHA and ESC
Updates in Heart Failure (HF) 2016: ACC / AHA and ESC Patrick McBride, MD, MPH Professor of Medicine & Family Medicine, UW School of Medicine and Public Health Special thanks to: Clyde W. Yancy, MD, MSc
More informationNew Paradigms in Rx of Symptomati Heart Failure:Role of Ivabradine & Angiotensin Neprilysin Inhibition
New Paradigms in Rx of Symptomati Heart Failure:Role of Ivabradine & Angiotensin Neprilysin Inhibition Prakash Deedwania, MD, FACC, FACP, FCCP, FAHA Professor of Medicine, UCSF School of Medicine, Director,
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Is there a mortality risk associated with aspirin use in heart failure? Results from a large community based cohort Margaret Bermingham, Mary-Kate Shanahan, Saki Miwa,
More informationMedical management of LV aneurysm and subsequent cardiac remodeling: is it enough? J. Parissis Attikon University Hospital Athens, Greece
Medical management of LV aneurysm and subsequent cardiac remodeling: is it enough? J. Parissis Attikon University Hospital Athens, Greece Disclosures Grants: ALARM investigator received research grants
More informationThe Hearth Rate modulators. How to optimise treatment
The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,
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 informationCardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides
Cardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides Colette Seifer MB(Hons) FRCP(UK) Associate Professor, University of Manitoba, Cardiologist, Cardiac Sciences Program, St Boniface Hospital
More informationHeart Failure New Drugs- Updated Guidelines
Heart Failure New Drugs- Updated Guidelines Eileen Handberg, PhD, ANP-BC, FAHA, FACC Professor of Medicine Division of Cardiovascular Medicine University of Florida Disclosures 1. 3 2. 6 3. 8 4. 11 Dunlay
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 informationSliwa et al. JACC 2004;44:
TREATMENT OF ADVANCED HEART FAILURE HEART DISEASE IN KENTUCKY Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac
More informationHeart Failure and Atrial Fibrillation
Heart Failure and Atrial Fibrillation 신미승 가천의대심장내과 Prevalence of AF & CHF AF : the most common cardiac arrhythmia more than 2.2 million Americans -- 2007 ACC CHF : more than 5 million Americans The prevalence
More informationBehandlungsalgorithmus bei Herzinsuffizienz mit reduzierter Auswurffraktion
Behandlungsalgorithmus bei Herzinsuffizienz mit reduzierter Auswurffraktion Professor Dr. med. Roger Hullin Leiter Programm für Schwere Herzinsuffizienz, VAD & Herztransplantation Suisse Romande Klinik
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 informationHeart Failure in Women: Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre
Heart Failure in Women: More than EF? Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre Overview Review pathophysiology as it relates to diagnosis and management Rational approach to workup:
More informationHEART FAILURE PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
HEART FAILURE PHARMACOLOGY University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 LEARNING OBJECTIVES Understand the effects of heart failure in the body
More 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 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 informationAll in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER
ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)
More informationHeart Failure in Women
Heart Failure in Women Disclosure Professor Sindone has received honoraria, speaker fees, consultancy fees, is a member of advisory boards or has appeared on expert panels for: Professor Andrew Sindone
More informationSatish K Surabhi, MD.FACC,FSCAI,RPVI Medical Director, Cardiac Cath Labs AnMed Health Heart & Vascular Care
Satish K Surabhi, MD.FACC,FSCAI,RPVI Medical Director, Cardiac Cath Labs AnMed Health Heart & Vascular Care None Fig. 1. Progression of Heart Failure.With each hospitalization for acute heart failure,
More informationKnown Actions of Digoxin
Known Actions of Digoxin Hemodynamic effects in heart failure Increases cardiac output, no effect on blood pressure Decreases PCWP Increases LVEF (
More informationUpdate in Cardiology What s Hot in 2017?
Update in Cardiology What s Hot in 2017? Mark R. Milunski, MD, FACC, FACP Chief, Cardiology Section Orlando Veterans Affairs Medical Center Associate Professor of Medicine University of Central Florida
More informationAtrial fibrillation and mortality: where is the missing link? Isabelle C Van Gelder University Medical Center Groningen
Atrial fibrillation and mortality: where is the missing link? Isabelle C Van Gelder The Netherlands Madrid Europace June 2011 Conflict of interests Research grants from Medtronic, SJM, Biotronik, Boston,
More informationTrials Enrolled subjects Findings Fox et al. 2014, SIGNIFY 1
Appendix 5 (as supplied by the authors): Published trials on the effect of ivabradine on outcomes including mortality in patients with different cardiovascular diseases Trials Enrolled subjects Findings
More informationDevice Based Therapy for the Failing Heart: ICD and Cardiac Resynchronization Rx
Device Based Therapy for the Failing Heart: ICD and Cardiac Resynchronization Rx Charles Gottlieb, MD Director of Electrophysiology Abington Memorial Hospital Heart Failure Mortality Mechanism of death
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 information1/4/18. Heart Failure Guideline Review and Update. Disclosure. Pharmacist Objectives. Pharmacy Technician Objectives. What is Heart Failure?
Disclosure Heart Failure Guideline Review and Update I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation. Natalie Beiter,
More 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 informationNew Strategies For Treating Patients With Chronic Heart Failure
New Strategies For Treating Patients With Chronic Heart Failure Barry Greenberg MD Professor of Medicine Director, Advanced Heart Failure Treatment Program University of California, San Diego Disclosures
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 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 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 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 informationDisclosures for Presenter
A Comparison of Angiotensin Receptor- Neprilysin Inhibition (ARNI) With ACE Inhibition in the Long-Term Treatment of Chronic Heart Failure With a Reduced Ejection Fraction Milton Packer, John J.V. McMurray,
More informationThe Role of ICD Therapy in Cardiac Resynchronization
The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine
More informationArrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh
Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention
More informationOnline Appendix (JACC )
Beta blockers in Heart Failure Collaborative Group Online Appendix (JACC013117-0413) Heart rate, heart rhythm and prognostic effect of beta-blockers in heart failure: individual-patient data meta-analysis
More informationCRT: whom does it benefit?
CRT: whom does it benefit? Francisco Leyva BSH Revalidation and Training 2018 Queen Elizabeth Hospital NICE guidelines for CRT LVEF 35% NYHA class I II III IV QRS
More information