this presentation gives latest ACC/AHA guidline to treat heart failure with preserved ejection fraction

1. MANAGEMENT OF HEART
FAILURE WITH PRESERVED
EJECTION FRACTION- MYTHS
AND REALITIES
PRESENTED BY:
DR. RAHUL GUPTA
RMO III
NSCB MEDICAL COLLEGE

2. INTRODUCTION
ACC / AHA guidelines define heart failure as-
• Complex clinical syndrome resulting from structural and/or functional impairment of ventricular filling or
ejection of blood.
TERMINOLOGIES:
• Older terms-
• systolic and diastolic heart failure
• Newer terms-
• HFrEF- EF< 40%
• HFpEF- EF ≥50%
• HFpEF borderline- EF 41-49%
• HFpEF,improved-EF >40%

3. CLASS OF RECOMMENDATION(COR) :
• It is an estimate of the size of the treatment effect considering risks versus benefit in addition to
evidence and/or agreement that a given treatment or procedure is/ is not useful/effective or in some
situations may cause harm.
LEVEL OF EVIDENCE(LOE) :
• It is an estimate of the certainty or precision of the treatment effect.

12. MYTHS AND FACTS
• MYTH: There are no Food and Drug Administration(FDA) approves device therapies for HFpEF
• FACT: There are promising devices like IASD in the pipeline
• REDUCE LAP-HF phase I study: it is a multicenter, open-label, single-arm study to assess transcatheter IASD
• IASD was implanted in :
1. Age >40 years
2. Symptom of HFpEF despite of GDMT
3. EF >40%
4. PCWP >15mmHg at rest and >25mmHg at exercise
• IASD implant proved to be safe and well tolerated and was accompanied by reduction in PCWP.

13. MYTHS AND FACTS
• MYTH: HF is an epidemic
• FACT: HF is a global pandemic
• HF affects around 26 million people worldwide
• 50% of HFpEF die within 5 years from day of diagnosis
• Pillai and Ganapathi estimated number of HF patients as 22.7 million in India and 30 million in South
Asia in 2011.

14. MYTHS AND FACTS
• MYTH: There are no effective therapies for HFpEF – doomsday is nearing
• FACT: the best way to control HF pandemic is to prevent it
• Simple measures to promote exercise, yoga, healthy diet and keeping strict check on smoking,
pollution, body weight, BP, atherosclerotic disease and diabetes can drastically reduce incidence of HF.

15. INDIAN PERSPECTIVE
• Burden of HF in India appears to be very high
• Primary prevention in HF in asymptomatic patients targets the three major modifiable HF risk factors
i.e. hypertension, atherosclerotic disease and diabetes.
• Restriction of salt intake and tobacco consumption can lead to surprising results
• Taxation, excise duties effectively implemented to cover not only branded but also unbranded, local
made tobacco products like bidi, cigarettes, snuff, tamaku, etc- would be the most powerful tool to
reduce incidence of CAD, HF, cancer in Indian population.

16. VIRTUAL WAR ROOM
• OPERATION JUGAAD:
 Ultra strict public policies (measures to promote exercise, yoga, reduction of salt, fat; elimination of
tobacco, pollution and keeping strict check on body weight, BP and diabetes) to be considered by
governing agencies which will create situation wherein the incidence of HF will nose to dive to the
lowest level ever in the history of medicine.
 This will create enough space and time to deal with the highly prevalent HFpEF.
 This bridge protocol will give necessary time required for landmark clinical trial and innovative trial like
drugs LCZ696 and devices like IASD.
 For low middle- income countries , it would be prudent to concentrate on primordial, primary,
secondary and tertiary prevention rather than spending money on unproven and semi proven
therapies.