Heart failure
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    Heart failure Heart failure Presentation Transcript

    • Heart Failure An overview
      • The Management of Heart Failure:
      • The Past, the Present, and the Future
      • Eugene Braunwald, MD
      Volume 1, Issue 1; May, 2008
    • OBJECTIVES
      • Disease Burden
      • 2.Heart Failure Therapy in the Past, Present and Future.
    • IS IT A PANDEMIC???
    • Number 1 Killer
    • 5.7Million Americans
    • Mortality has more than doubled since 1979
    • >65years Leading cause of hospitalization
    • 1-2% of Health Care cost $ 39.2 Billion
    • 5 years from diagnosis only 50% alive
    • The Past
    • 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
    • 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
    • The Present
    • Level of Evidence LEVEL OF EVIDENCE C A
    • 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
    • Copyright ©2008 American Heart Association Management of heart failure over the past 40 years Katz, A. M. Circ Heart Fail 2008;1:63-71
    •  
    • 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
    • Cardiac Resynchronization Therapy Prolongs Survival in Patients With Left Ventricular Dysfunction: A Meta-Analysis
          • McAlister FA. JAMA. 2007;297:2502 .
      • 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 .
    •  
    • 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
    • Left Ventricular Assist Devices (LVAD) The Jarvik-7 The Jarvik 2000 The World's First Artificial Heart
    • Indications
      • Bridge to Transplantation
      • Bridge to Recovery
      • Destination Therapy
    • Transcutaneous Ventricular Assist Device
    • Implantable Ventricular Assist Device
    • Ventricular Assist Device in the market HeartMate II® Arrow LionHeart DeBakey LVAD Thoratec CentriMag® Thoratec PVAD™ Thoratec IVAD™ HeartMate® XVE
    • Surgeries for heart failure
    • Coronary Revascularization
    • Valvular Surgery
    • Left Ventricular Reconstructive Surgery (Dor Procedure)
    • Batista Procedure
    • Cardiac Transplant At Groote Schuur Hospital On December 3 rd 1967
    • Mr. Louis Washkansky lived for 18 days Smithsonian‘s National Museum of American History
    • 250,000 deaths per year Only 2000 donor hearts available
    • Never make predictions
    • Genetic Mutations
    • Insertion/deletion polymorphism within the ACE gene Polymorphism of the adrenergic α 2c receptor and of the β1 adrenergic receptor
    • CELL BASED THERAPY
    •  
    • PREVENTION
        • Thank you