33 years heart failure journey ,unique experience from heart failure clinic to CCPC heart Failure .

1. Dr Asadullah Khan Soomro
Adult Cardiologist & Heart Failure specialist
Altamash General Hospital Block 1 Clifton Karachi
Contact no; 0302 - 2308718
Email; hssbasadsoomro@gmail.com
33 years Heart Failure Journey
Heart Failure Clinic to Heart Failure Programme &
( CCPC , HF Accredited by JCI )

2. I was born in Soomro family of Ratodero distt Larkana , graduated from Chandka medical college Larkana in 1985 . After internship in
general medicine and surgery at Civil Hospital karachi , I did three years hectic training at National institute of cardiovascular diseases
( NICVD ) Karachi Pakistan , and joined Royal Brompton National Heart & Lung Institute University of London (1989 to 1990 batch) one of the
students from all over world . After passing examination , got clinical attachment at Hillingdon hospital London ,had honor to work with Prof
Philip Poole Wilson and Dr GC Sutton , learned art of heart failure and clinical cardiology until April 1991. Returned back to Pakistan,
passed grade 18 Sindh Public service commission in flying colors ,secured first position in Sindh province and appointed senior registrar
cardiology at Dow medical and Civil hospital Karachi . Established first heart failure clinic in 1993 ,unique in country ,presented results
of 330 heart failure patients audit in Golden Jubilee and centenary 50/100 Dow medical College and Civil hospital Karachi in December 1996
( First largest local HF registry in Sindh) .
Came to Al Ahsa KSA joined King Fahad hospital ministry of health in January 2002, elevated to work as consultant & head of cardiology
division ( thanks to Dr Mehmoud al Bagshi) .Organized various heart failure symposiums in Al-Ahssa region. Offered to join Prince sultan
Cardiac center in 2007.Being PSCCH pioneer physician , I had honor to established three specialized clinics for , adult congenital heart disease
,Valve disease clinic and First heart failure clinic in region indeed. Completed my journey from heart failure clinic in Oct 2007 to
multidisciplinary heart failure programme in October 2017. During this period registered 550 patients with acute heart failure, unique in Al -
Ahssa health Eastern province Kingdom of Saudi Arabia . I had unique dual honor of being morbidity and mortality co-ordinator for 8 years
and CCPC Heart failure co-ordinator in 2017 ) . With in 6 months of dynamic team efforts Special thanks to Dr Khalil Kayam and his quality
team, our prestigious ( PSCCH) heart center accredited by JCI as first and only heart center in middle east as CCPC ( Clinical Care Programme
certification ) achiever in heart failure. ( All 3 Step PSCCH 10 years journey , Heart Failure Clinic, MDHF program & CCPC Heart Failure )
33 years ( 1990 – 2023 )
Heart Failure journey

3. In August 2018 joined king Abdullah medical city holy Makkah ( KAMC ). Reactivated heart failure clinic on every
Tuesday evening from October 2018, with support of Dr Burai Adlan , Dr Najeeb Jaha, Dr Abdullah Essam Ghabashi and
support of adult cardiology/surgery department indeed .
We established network of multidisciplinary out patient HF services including cardio-oncology especially ,
chemotherapy induced cardiomyopathy ,had unique honor to provide intradepartmental heart failure consultation
service to patients admitted with acute heart failure, provided services of rapid access heart failure ( RAHFC ) and post
discharge heart failure clinic services ( PDHFC) to prevent ist admission and recurrent hospitalization especially to
vulnerable patients in vulnerable phase.
Registered around 993 HF patients including hajjis ( 2019) from various countries. First time started HF novel drug
( Sacubitril/Entresto) on 8th October 2018 until May 2021, 330 sacubitril patients registered and followed them closely .
52.1 % of them titrated to target dose of 200 mg ( highest in Makkah region). I wish could have worked to have CCPC
,KAMC Makkah region, but I stand retire and decided to join family on 3rd July 2022 .
Last not the least , Iam grateful to all who gave me tough time and who helped me all along.
Jazak Allah khairan Ya Akhwan.
33 years( 1990 – 2023 )
Heart Failure Journey

4. ( Dr GC Sutton , my Heart Failure mentor and his team)
Hillingdon Hospital London (1990 to 1991) My heart
failure journey started from here

5. Heart Failure Journey at Civil hospital and Dow medical
College Karachi ( Established First heart Failure Clinic in Pakistan
& HF registry at CHK 1995 to 1997 )
ABSTRACT
HEART FAILURE AUDIT
Dr. Asadullah Khan Soomro, Dr. F. Memon, Dr. Riaz, Prof. Illahi Bukhsh M. Soomro, Department
of Cardiology, Dow Medical College & Civil Hospital, Karachi.
( Email, hssbasadsoomro@gmail.com)
Heart failure is a serious public health problem. It is not a diagnosis itself but a complex syndrome
with multiple etiologies. Despite tremendous research, yet management would frequently
depend upon etiology of heart failure.
372 patients registered at the of the Department of Cardiology, Civil Hospital Karachi during 15-3-
1995 to 15-1-1997. Out of 372 patients, 243 (67.32%) were Men and 129 (34.68%) Women.
214 ( 57.5 % ) were above 50 years of age and less than 50 years of age. Average age was 48.12
years.
Etiologically coronary artery disease was 164 (44.08%), rheumatic valvular heart disease 88
(23.65%), hypertensive heart failure 31 (8.33%), cardiomyopathies 19 (5.1%), congenital
15 (4.04%), pericardial 12 (3.22%), post cardiac surgical 17 (4.75%), and others were 26 (6.99%),
ECG was abnormal in 97% of patients with HF and systolic dysfunction, hence normal ECG would
make one suspicious that heart failure is unlikely diagnosis, atrial fibrillation was the
commonest rhythm disorder. Echocardiogram was done in 285 (76.61%) patients, majority of
patients 187 (65.6% ) showed systolic dysfunction.
Total number of patients who died were 32 (8.6%), 18 ( 56.2%) men and 14 were women ( 43.7%)
over all mortality in men ( 7.4% ) and in women 10.8%.. Average age 58.94 years.
Conclusion ; Our heart failure patients are 10-15 years younger than western population .
Etiological diagnosis is mandatory to detect one of the less common but potentially reversible
causes of heart failure. Athero thrombotic CAD especially previous myocardial infarction with LV
systolic dysfunction was most common cause of heart failure .

6. I was appointed as Clinical care Heart Failure program ( CCPC) co-ordinator
on 2nd April 2017. CCPC heart failure was accredited by JCI on 18th October
2017 ( with JCI CCPC HF Surveyor Brenda K. Shelton ) just in 6 months.
Dr Soomro’s Heart failure Journey at PSCCH
Established first Heart failure Clinic at Prince Sultan Cardiac Center Al - Ahassa region in 2007 to
Clinical care Heart Failure Programme ( CCPC ) . First in middle East October 2017.
It was not just a 6 months game but my journey started while working as head of cardiology in King
Fahad hospital Hofuf, Being first physician, to join PSCCH,I alone screened all the cardiac patients from
King Fahad hospital , and registered them on specialized clinics ,like adult congenital heart ,Valve disease
and heart failure clinic indeed. I registered around 550 acute heart failure patients admitted to PSCCH
during 2011 to 2017.

7. Dr Asadullah Soomro
Morbidity & Mortality Co-Ordinator PSCCH Al-Ahsa KSA
October 2009 to October 2017
I was assigned a job of morbidity & mortality coordinator on
6th September 2009 . Ist morbidity & mortality round was held on
Monday afternoon 30th Shawal 1430 (19.10. 2009).
Ist case was 87 year male who was admitted on 15th Shawal 1430 at
1.25am Sunday on CCU bed 6 . He was admitted through ER with missed
MI ( LBBB on EKG) No DM HTN only smoker. Echo showed akinetic anterior
wall severe LV systolic dysfunction EF 15-20%, Not thrombolysed.
Complicated by cardiogenic shock. Intubated & ventilated on iontrops and
expired on same day at 7.50 am ( with in 9-10 hours of admission ) .
After 8 years journey , Last case I audited ,76 year male ,DM, PAD,
presented with acute anterior wall STEMI with RBBB ,complicated by
cardiogenic shock at presentation.
Admitted on Tuesday 24th October 2017 at 1.51pm, shifted to cath lab .
CAG showed multi vessel CAD. RCA was CTO ,LAD total thrombotic
occlusion proximally, intubated ventilated, on ionotropic support . During
PCI to culprit LAD further complicated by ventricular fibrillation,
resuscitation done but failed and expired at 3.51pm ( With in 2 hours of
admission) .
Meeting was regularly held on every last Monday of the month .
It was initiated by Dr Abdullah Essam Ghabashi , I alone audited around 250 deaths ,
openly discussed on power point slide presentation amongst hospital physicians and
Nursing supervisors . All deaths were discussed openly to learn from our mistakes
,regardless of color ,class & creed . It was ended during tenure of Dr Khalid al Khamees

8. Heart Failure Journey From 2018 to 2021
King Abdullah Medical City ( KAMC ) Holy Makkah .
Heart Failure Program co-ordinator , member of GWTG ( AHA ) .

15. One of the accreditation warriors & Heart Failure coordinator.
Dr Soomro Heart Failure programme coordinator & one of the HF CCPC accreditation warriors .

16. Few Brilliant ladies of the quality department Sister daisy ,Martina, Rachel, sister Doaa, Sister Rowena and her team .
Received certificate as documentation
champian from PSCCH .

17. DR. ASADULLAH SOOMRO
Adult Cardiology Specialist
2007-2018
CCPC heart failure was a great achievement , and combined effort of the whole team, Dr Khalil Kayam quality consultant was
instrumental in proposing me to accept this challenging task as a heart failure programme co ordinator.
On the top in blue suit is dr Sandeep he was CCPC acute MI co ordinator. This was a visit to Ayoun hospital to familiarize local
physicians regarding community heart failure and network .On extreme right with me Dr Haider and on left dedicated quality managers. Dr
Kayam in down black shirt . It was a memorable time , when PSCCH win double CCPC award in one go heart failure and acute MI
,first in middle east .

18. Dr Ayman my old KFHH Colleague and neighbour , who gave me tough time
in CCPC heart failure, which was broadly compensated by my friend Dr
Ahmed Zanata .

19. Heart Failure Percentership ( delegates from different countries ) National
Guard Hospital Riyadh

21. With chairman of the 6th Asia Pacific Heart failure Symposium
Feb 2012 La meridian Chiangmai Thailand .

23. 4th World Heart Failure Congress (December 2014 Al –Ain UAE ).

24. MHFR ( Makkah Heart Failure Registry)
Saudi Heart Association Conference 7th October 2021
Total Patients 993 Average Age 56.9 + _ 13.2 years ( Men 752 ( 75.7% ) Women 241( 24%
Patients Demography and clinical characteristics
Registry groups &
No of Patients
Location of registry
Type of Registry
Average Age
Men/ Women %
Ischemic Etiology
Valvular Etiology
On Target Dose
Of Sacubitril
Average LVEF %
HF in Saudis
Deaths = 90
Group I = 330 ( 33.2% ) Group II = 586 ( 59% ) Group III = 77 ( 7.7% )
Acute & chronic HF KAMC Cardiac
Center ( October 2018 to June 21)
Acute & Chronic HF KAMC Cardiac
Center ( October 2018 to June 21 )
Acute HF KAMC Cardiac Center
30 Days ,August Hajj 2019
Sacubitril Registry EF < 40%
HF with Systolic dysfunction
Non Sacubitril Registry
Both systolic and Perserved EF
Non Sacubitril Registry
Both Systolic & Perserved EF
53.9 +_ 12.3 Years 57.7 + _ 13.5 Years 63.8 + _ 10.8 Years
Men 278 ( 83.5 % ) Women 52 ( 15.7% ) Men 424 (72.2 % ) Women 162 ( 27.6%) Men 50( 64.9 % ) Women 27 ( 35% )
128/330 ( 38.7% ) 250/586 ( 42.6% ) 50/77 ( 64.9% )
15/202 non ischemic ( 7.4% ) 95/ 314 ( Non ischemic ) 30.2% 15/27 ( Non ischemic ) 55.5%
172/ 330 ( 52.1% ) Not Prescribed Not Prescribed
23.2 + _ 7.4% 31.7 + _ 10.8 % 33.8 + _ 0.4%
290/330 ( 87.8% ) 524/685 ( 89.4% ) 2/77 ( 2.5 % )
23 /330 ( 6.9% ) M = 18, F = 5 52/586 ( 8.8 % ) M = 42 F = 10 15/77 ( 19.4% ) M = 11, F = 4
MHFR ( Makkah Heart Failure Registry)
Saudi Heart Association Conference 7th October 2021
Total Patients 993 Average Age 56.9 + _ 13.2 years ( Men 752 ( 75.7% ) Women 241( 24%
Patients Demography and clinical characteristics

26. Soomro’s
Parsimonious Model of Multidisciplinary State of Art
Heart Failure Program Sindh / Pakistan .
Home Based
Heart Failure
Service
Virtual
Heart Failure
Service
Outpatient
Heart Failure
Service
Emergency
Heart Failure
Service
Community
Heart Failure
Service
Inpatient
Heart Failure
Service
4
2
3
1
5
6

27. This Clinic is for new onset ( De-Novo ) HF patients with mild to moderate symptoms , or suspected heart failure
patients & those who left DAMA from ER, its walk in clinic . Target is all basic HF work up on same day.
This clinic is for those patients who were admitted & discharge from the ward ,CCU,ICU with diagnosis of ADCHF ( Acute
decompensation of chronic HF ) & New onset Heart Failure. ( Telephonic call on 3rd day and clinic appointment With in 10-15 days post discharge)
This clinic is for tiny group of complex ambulatory advanced heart failure stage D , not suitable for advanced therapies ( LVAD or OHT )
or waiting for advanced therapies &for those with Post LVAD /Post heart transplant.
This community based HF clinic for care of stage A and stage B Heart failure . With mild to moderate new onset HF patients for early
referral to RAHFC & For post discharge early follow up / HF education and self care Zone awareness at community level.
This clinic is for Compensated HF patients who are living away from Karachi can follow on this clinic ,if need can be
reviewed on regular HF clinic. ( To save thousands of Km travel, petrol, time , leave and cost saving indeed )
This clinic is for compensated HF patients under follow up /and for those who require Guide line directed medical
therapy (GDMT ) dose titration until fulfill dispose criteria .
This clinic is for those patients who are in need of regular I/V diuretics & inotropes on OPD basis to avoid frequent
ER visits and readmissions. This clinic can be utilized for ER patients who refuse admission/DAMA as an alternative.
Its multidisciplinary clinic for HF education, clinical pharmacist medication ,Dietary education , HF rehabilitation
,social problems , anti smoking and drug counseling issues & miscellaneous problems.
This clinic is exclusively for Cardio-oncological problems with heart failure evaluation & follow up.( post Chemo & radiotherapy )
Cardio-obstetric HF clinic is for heart diseases in pregnancy and Peri-partum cardiomyopathy patients .
Rapid Access HF Clinic
Post Discharge HF
Clinic
Advanced HF Clinic
Community HF Clinic
Virtual HF Clinic
Regular HF Clinic
Same day HF Clinic
Nurse Led HF Clinic
Cardio-oncology &
Cardio-Obstetric Clinic
Soomro’s
Network of Novel Heart Failure
Clinics , Sindh/Pakistan

28. Aziz Medicare
Soomro’s Classification of Heart Failure Network
Model 1, Community Heart Failure Clinics
Heart failure service with only ,out patient clinic capability .
Admission
Model 2
Heart Failure service with OPD , emergency
and in patient capability but without cath Lab.
Model 4
All + Advanced Heart Failure service
With Intervention, LVAD and
Cardiac transplant Capability.
Grade /
Level
I
To
IV
Model 3
Heart Failure service Model 2 +
Cath lab & revascularization
capability
Soomro’s
Classification of Inter-hospital Heart Failure network

29. Proposed organization levels and minimum requirements for Heart
failure program /clinic network .
I Heart Failure
Clinic
Secondary
Hospitals
Cardiologist with
HF training /
Experience /
HF interest . HF
Nurse .
Outpatient clinic
Inpatient ward
General ICU
Echo /Stress / Lab
Clinical assessment
EKG, Xray , ultrasound
6 min walk test,
Echo & Stress lab
Biochemical tests
Pro BNP/troponin
HF clinical management
Emergency department
Inpatient ward
ICU hospitalization
II Heart Failure
Unit
Large Secondary
or tertiary /
University
Hospital
Cardiologist
Heart Failure
Expert
All above plus
CCU ,Cath lab
Cardiac CT
EP Lab
All above plus
cardiopulmonary exercise
test ( CPET )
transesophageal Echo
Cardiac CT ,Cath Lab with
EP lab
All above plus
Coronary artery
intervention
Device implantation
ICD /CRTD Advanced ICU
Venous ultrafiltration
III Heart Failure
Centre
Large tertiary or
University
hospital in
provincial capital
Cardiologist
Heart Failure
Expert
All above plus
Cardiac MRI
Cardiac Perfusion
scan & cardiac
All above plus
Cardiac MRI, 3 D Echo
Nuclear cardiology
Advanced EP
Endomyocardial biopsy
All above plus
Transcatheter valve
implantation or valve repair.
Advanced EP intervention like
VT ablation. Cardiac surgery,
MCS assist device implant
& Heart transplantation.
Level Unit name Location Personnel Infrastructure Diagnostic
assessments
Therapeutic
intervention
Organization Structure & Function
Heterogeneity in composition of HF clinics. 81% HF clinics run by cardiologist , 80% based in hospitals and only 26% based in academic centers .No home based HF clinics .

30. A
&
B
56
%
C
D
HF
Stage
A-D
Color
Code

31. Heart Failure Admission and
Readmission Syndromes
Dual Epidemic of
Two different heart failure Worlds.
Costly & deadly Syndromes
“ Science or Art ? ”
P
D
H
F
C
R
A
H
F
C
Rapid Access
Heart Failure Clinic
Post Discharge
Heart Failure Clinic
Heart Failure Admission & Readmission
Syndromes

32. Heart Failure
Readmission Syndromes
Dr Asadullah Khan Soomro
Adult Cardiologist
King Abdullah Medical City Holy Makkah
Email, hssbasadsoomro@gmail.com
Post Discharge
Heart Failure
Clinic.
“ Scince or Art”

33. .
Improving Heart Failure
Services For People in Holy Makkah.
MHFS
Makkah Heart Failure Service
Asadullah Khan Soomro
Adult Cardiologist
King Abdullah Medical City Holy Makkah
Why do we need Community
Heart failure Service ?

34. Emergency Heart Failure
Services
Dr Asadullah Khan Soomro
Adult Cardiologist
King Abdullah Medical City Holy Makkah
Email; hssbasadsoomro@gmail.com
Holy Makkah
Emergency Department
Heart Failure Services.
“ Difficult but not Impossible”

35. Heart Failure Admission and
Readmission Syndromes
Dr Asadullah Khan Soomro
Adult Cardiologist
King Abdullah Medical City Holy Makkah
Email, hssbasadsoomro@gmail.com
“ Can We Predict or
Prevent it ? ”

36. KAMC,
Cardio – Oncology
Syndromes
“Cancer and Cardiovascular disease.
Two Medical Worlds Collide”

37. Comprehensive
Cardiopulmonary
Exercise Test ( CPET) in
Left Ventricular Assist Device ( LVAD)
“ Before, During & After”
2nd Saudi prevent symposium 26 -27th may 2019 Hilton Jeddah
ASADULLAH KHAN SOOMRO
ADULT CARDIOLOGIST
KING ABDULLAH MEDICAL CITY HOLLY MAKKAH
Email, hssbasadsoomro@gmail.com

38. “EXERCISE
PRESCRIPTION”
For Comprehensive
Cardiac Rehabilitation
2nd Saudi prevent symposium 26 -27th may 2019 Hilton Jeddah
ASADULLAH KHAN SOOMRO
ADULT CARDIOLOGIST
KING ABDULLAH MEDICAL CITY HOLLY MAKKAH

39. SOOMRO,S , CLASSIFICATION OF
ISCHEMIC HEART FAILURE SYNDROMES
ISCHEMIC
HEART FAILURE
WITH MYOCARDIAL
INFARCTION.
4
3 ISCHEMIC
HEART FAILURE
WITHOUT MYOCARDIAL
INFARCTION.
Subjective & objective evidence of healed (
Old ) myocardial infarction, complicated by
first time or recurrent heart failure
hospitalization.
2
Subjective & objective evidence of
acute myocardial infarction,
complicated by heart failure during
index hospitalization.
1
Primary symptoms of heart failure,
without symptoms of angina and
myocardial infarction ( Neither objective
evidence of MI ).
Concomitent symptoms of angina and
heart failure, without subjective or
objective evidence of myocardial
infarction.

40. Soomro’s Classification of Heart Failure
Syndromes
.
Acute De-Novo
Heart Failure syndromes
Chronic Heart Failure
Syndromes
Chronic
Compensated
Stage C Acute
Decompensation
of Chronic HF
Stage C
Chronic
Advanced HF
Syndromes
Stage D
Acute
De-Novo
Simple Acute
De-Novo
Complex
Acute
De-Novo
Malignant
“Benign or Malignant ?”

41. Amphetamine & Hashish Induced Heart Attack
and Heart Failure Syndromes, with severe
biventricular systolic dysfunction and
huge thrombus and cardio-embolization.
“ Epidemic of Captagon induced cardiomyopathy “
“ Devilish Dual Epidemic Of
Cannabis & Captagon “
( The Gateway Drugs )
“ Hashish, Marijuana & Bango”
Black Hashish
Asadullah Khan Soomro, Adult Cardiologist. Email : hssbasadsoomro@gmail.com )

42. When The Heart Kills
The Liver
Acute Cardiogenic Liver Injury
In Heart Failure syndromes
Why Cardiologist is inetrested in Liver ?
Asadullah Khan Soomro,Adult Cardiologist KAMC Holy Makkah
Email: hssbasadsoomto@gmail.com
Small but treacherous Huge but Pliant

43. Scorpion Cardiomyopathy
“ Reversible Heart Failure”
Asadullah Khan Soomro
Adult Cardiologist
King Abdullah Medical City Holy Makkah.

44. HEART FAILURE
Research
“ chose your project “
HEART
FAILURE WORLD
Chronic non ischemic advanced Heart Failure
Big ( elephant heart ) expired after two years with recurrent readmissions.
Acute de-novo ischemic type 1 malignant HF .
expired during index admission ( small tiger heart )
Chronic ischemic ( type 11) advanced HF ,expired after > 100 HF readmissions ,refractory ascites and this is his
infected umblical hernia
RCA of Ischemic HF ( type 1V ) expired after CABG
Malignant HF ,33 male Inf STEMI RV extension ,complicated by VSR expired . 30 yr F Cong VSD with HF right heart thrombus
died of pulm embolism
HF with Left main occlusion and polymorph VT(
shown on right., after PCI living with chronic HF
Ischemic HF type 111 with angina Typical ST elevation in
Avr & V1 total ST score > 18mm Left main 3VD CAD ,did
early CABG
50 Yr F presented with de novo HF .this is her LA
myxoma after surgery
Elephant in heart, huge myxoma
Asadullah Khan Soomro
KAMC Makkah; hssbasadsoomro@gmail.com

45. Ist Post Discharge Heart failure Case Experience
Transition from in patient ( ADCHF ( 15.10.2018 ) to home & OPD February 2021.
“ Heart failure journey from recurrent decompensation to compensated phase ,0% readmission in 2 Yrs
“ Time to go home ,good by KSA “
High altitude Heart Failure in mountains of Taif ( unique Experience)

46. Heart Failure Syndromes
“When to contact physician or visit ER ”
Every heart failure patient,
family ,paramedical personnel
and community physicians
indeed should be aware of heart
failure Zones .
Ideally every patient ,every
day should be green
“ Ever Green”
Score Zero
Yellow
Zone
Get alert ,
Warning Signs
( Number 1 to 5)
Adjust your fluid,
salt, diuretic or call
your physician
Red
Zone
Emergency
( Call ambulance
To visit ER.
If number
6 to 10 )
Heart failure Zones
Every heart failure patient should learn and monitor his weight ( before breakfast and after free from bath room) check edema, assess your symptoms and
medications.Those who are in green zone ( Mabrook ) 90% HF compensated patients who are regularly following physicians recommendation fast successfully
Except those who are already in transitional phase/ advanced heart failure FC 111,or those who are non adherrant to dietary /fluid medications and with new
precipitants ( like ischemia & infections ). They are the ones who suffer and repeatedly visit ER and hospitalized during Ramdan. Follow your HF Zones please:

47. Top 15 tips for healthy
Heart Failure Living
per day
1) Understand your disease, like heart failure etiology ,ischemic/non ischemic, Dilated systolic
dysfunction, EF 40% ,non dilated perserved EF >50%.NYHA FC 1-1V. HF stages A asymptomatic to D &
E advanced HF. New onset HF, ADHF, compensated HF,Vulnerability for admission readmission.
9)Restrict fluids to 1.5 lit and salt 2 gram per day, until congested and volume over loaded. Make sure
you are on maximum tolerated dose of guide line directed / indicated device therapy. check
electrolytes, renal ( GFR) and liver function ,BNP ,uric acid periodically .
2) Understand HF risk factors ( DM,HTN ,smoking, dislipidaemias, drugs, infections ) Comorbidities
( Cancer, renal failure, COPD, thyroid ,anemia)
Decompensating factors for readmission, drug non adherence, ischemia
3) Understand the reversible etiology of heart failure & LV dysfunction
( like timely revascularization, corrective surgery for valve, congenital ,pericardial, ) peripartum
cardiomyopathy & cardiotoxic drugs &etc
4) Understand about heart failure education , self care and cardiac rehabilitation. ( patient & family
education, Paramedical personnel, physician and payers/managers education) .
5) Understand significance of multidisciplinary heart failure program ( CCPC ). HF journey
and clinical pathways for inpatient care ,out patient care, ( RAHFC, post discharge, regular &
advanced HF /device clinic) emergency HF care and community HF care .
6) Understand regional heart failure model of care & network, ( Model 1 community heart failure
service with, only out patient capability, model 11 HF service with emergency and inpatient
capability, model 111 advanced HF service with LVAD & transplant capability.
7) Understand heart failure cost and prevention of ist admission and readmission syndromes
,with introduction of multidisciplinary novel out patient clinics ( RAHFC ( diagnostic to prevent ist
unplanned admission) ,RAHFC prognostic ,RAHFC therapeutic to prevent ER visits) post discharge
heart failure clinic especially for vulnerable patient & vulnerable phase to prevent HF
readmissions and reduce cost..
8) If you have HF with LV systolic dysfunction ( EF < 40% ), secondary MR and pulmonary
hypertension. Not a surgical or device candidate .Understand your guide line directed
medications effects and side effects . Start with small dose of beta blockers ,ACE /ARB and novel
ARNI and spironolactone monitor tolerability and adverse effects ( especially symptomatic
hypotension ,K and creatnin) If all good titrate to maximum dose , & adhere .do not stop even
feel better.
10) We encourage physical activity, and graded exercise, sex is not contraindicated ,if dysfunction
consult physician before sex medications.
Say full stop ,and no to smoking / tobacco products, no to alcohol and recreational drugs like
captagon. Avoid NSAID ,Get seasonal vaccines.
11) If you are in permanent atrial fibrillation ,implanted device, I CD,CRTD ,PPM, and LVAD. Check and
keep your INR around 2 to 3. If unexplained fever, loss of appetite, hypotension, signs of stroke (
weakness ,head ache vomiting) ,sudden arm/leg severe pain with coldness, consult physician .
12) Know your medications especially loop diuretic ( furosemide ) play with them according to your
symptoms , if volume over load , > weight and edema can increase the dose to 100-200 mg per day
.consult your physician if unresponsive or in case of renal injury.Take care if were on chemothrapy
13) Daily weight record, every morning before break fast and after free from bath room .If weight gain
of > 2 pounds per day for 2 days or > 5 pounds a week or develop signs of fluid retention increase
dose of diuretics and discuss with your physician. All HF patients should know their dry weight ,when
decongested and stable Functional Class.
14) Understand heart failure zones, you should be ever green, yellow means be alert or contact
physician ,red is to go to emergency, if symptomatic hypotension, worsening of breathlessness and
angina at rest , syncopae ,fast heart beat, inappropriate ICD shocks ,signs of stroke, worsening of
major organ function, renal ,liver injury rhabdomyolysis
Check
Your
HF
Zone
Daily.
Be Ever green
If no dyspnea on
routine activity.
No weight gain, no
edema
Worsening of HF
symptoms, FC
111,1V. PND Weight
gain 2-3 pounds in
24 hours.
Sudden
Breathlessness,Angi
na,Palpitations with
syncope.
Hypotension
Call ambulance.
Heart Failure Zones
Email, hssbasadsoomro@ gmail.com

48. Heart Failure Services without HF programme
“ Zigzag/Disorganized”
“ Unfortunately Bitter truth ? Beginning of my Makkah HF journey “
Heart Failure Services without HF programme
“ Zigzag/Disorganized”

49. THANK YOU
Living Longer, Living Well