2.Heart Failure Therapy in the Past, Present and Future.
IS IT A PANDEMIC???
Number 1 Killer
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
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
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
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 .
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
Bridge to Transplantation
Bridge to Recovery
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
Left Ventricular Reconstructive Surgery (Dor 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
Insertion/deletion polymorphism within the ACE gene Polymorphism of the adrenergic α 2c receptor and of the β1 adrenergic receptor