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  • 1. Heart Failure An overview
  • 2.
    • The Management of Heart Failure:
    • The Past, the Present, and the Future
    • Eugene Braunwald, MD
    Volume 1, Issue 1; May, 2008
  • 3. OBJECTIVES
    • Disease Burden
    • 2.Heart Failure Therapy in the Past, Present and Future.
  • 4. IS IT A PANDEMIC???
  • 5. Number 1 Killer
  • 6. 5.7Million Americans
  • 7. Mortality has more than doubled since 1979
  • 8. >65years Leading cause of hospitalization
  • 9. 1-2% of Health Care cost $ 39.2 Billion
  • 10. 5 years from diagnosis only 50% alive
  • 11. The Past
  • 12. In 1950 first edition of Harrison’s Principles of Internal Medicine D ecubitus D ietary sodium restriction D igitalis D iuretics (mercurial) Venesection and Morphine The Management of Heart Failure: The Past, the Present, and the Future Eugene Braunwald,MD Circulation: Heart Failure. 2008;1:58-62
  • 13. In 1970 Sixth edition of Harrison’s Principles of Internal Medicine Diuretics ( Thiazide, Loop, Potassium sparing ) β-adrenergic agonist Precipitating cause The Management of Heart Failure: The Past, the Present, and the Future Eugene Braunwald,MD Circulation: Heart Failure. 2008;1:58-62
  • 14. The Present
  • 15. Level of Evidence LEVEL OF EVIDENCE C A
  • 16. ACE INHIBITORS or ARB BETA BLOCKERS DIURETICS DIGOXIN SPIRONOLACTONE OPT: Optimal Pharmacologic Therapy ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. 2001; 1-56. ADJUNCT: HYDRALAZINE and NITRATES
  • 17. Copyright ©2008 American Heart Association Management of heart failure over the past 40 years Katz, A. M. Circ Heart Fail 2008;1:63-71
  • 18.  
  • 19. Biventricular pacing therapy
    • INDICATIONS:
    • Sinus rhythm, QRS interval >=120 ms
    • LV systolic dysfunction LVEF (<=35%)
    • Persistent, moderate to severe HF (NYHA III) despite optimal medical therapy.
    (Strength of Evidence = A) http://www.heartfailureguideline.org 2010 Comprehensive Heart Failure Practice Guideline
  • 20. Cardiac Resynchronization Therapy Prolongs Survival in Patients With Left Ventricular Dysfunction: A Meta-Analysis
        • McAlister FA. JAMA. 2007;297:2502 .
  • 21.
    • Cardiac Resynchronization Therapy Prolongs Survival in Patients With Heart Failure (The CARE-HF Trial)
    Percentage of Patients Free of Death from Any Cause or Unplanned Hospitalization for Major Cardiovascular Event Percentage of Patients Free of Death from Any Cause Cleland JG et al. N Engl J Med. 2005:352;1539 .
  • 22.  
  • 23. ICD Therapy
    • CLASS I INDICATIONS:
    • Ischemic cardiomyopathy with LVEF
    • < 35%, at least 40 days post MI, NYHA class II OR III. (Strength of Evidence = A)
    • 2. Ischemic cardiomyopathy with LVEF < 30%, at least 40 days post MI, NYHA class I. (Strength of Evidence = A)
    • 3. Non Ischemic cardiomyopathy with LVEF ≤ 35%, NYHA class II OR III. (Strength of Evidence = B)
    The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
  • 24. Left Ventricular Assist Devices (LVAD) The Jarvik-7 The Jarvik 2000 The World's First Artificial Heart
  • 25. Indications
    • Bridge to Transplantation
    • Bridge to Recovery
    • Destination Therapy
  • 26. Transcutaneous Ventricular Assist Device
  • 27. Implantable Ventricular Assist Device
  • 28. Ventricular Assist Device in the market HeartMate II® Arrow LionHeart DeBakey LVAD Thoratec CentriMag® Thoratec PVAD™ Thoratec IVAD™ HeartMate® XVE
  • 29. Surgeries for heart failure
  • 30. Coronary Revascularization
  • 31. Valvular Surgery
  • 32. Left Ventricular Reconstructive Surgery (Dor Procedure)
  • 33. Batista Procedure
  • 34. Cardiac Transplant At Groote Schuur Hospital On December 3 rd 1967
  • 35. Mr. Louis Washkansky lived for 18 days Smithsonian‘s National Museum of American History
  • 36. 250,000 deaths per year Only 2000 donor hearts available
  • 37. Never make predictions
  • 38. Genetic Mutations
  • 39. Insertion/deletion polymorphism within the ACE gene Polymorphism of the adrenergic α 2c receptor and of the β1 adrenergic receptor
  • 40. CELL BASED THERAPY
  • 41.  
  • 42. PREVENTION
  • 43.
      • Thank you