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Heart Failure
Contributors to Increased Incidence
♥ Improvements in: ♥ Survival post-MI ♥ Technologies (i.e.. PCI, stents etc.) ♥ Medical Treatments for ischemic heart
disease (statin, ACE-I, ASA) ♥ Overall survival
Heart Failure Statistics
• Nearly 5 million Americans are currently living with CHF. • Approximately 550,000 new cases are diagnosed in the
U.S. each year. • Almost 1.4 million persons with CHF are under 60 years
of age. • CHF is present in 2 percent of persons age 40 to 59. • The incidence of CHF is equally frequent in men and
women, and African-Americans are 1.5 times more likely to develop heart failure than Caucasians.
Heart Failure Statistics
• Heart failure is responsible for 11 million physician visits each year, and more hospitalizations than all forms of cancer combined.
• CHF is the first-listed diagnosis in 875,000 hospitalizations, and the most common diagnosis in hospital patients age 65 years and older.
• More than half of those who develop CHF die within 5 years of diagnosis.
• Heart failure contributes to approximately 287,000 deaths a year
Mortality
♥ 287,000 patients die as a direct result of CHF per year
♥ 1-year mortality rate = 10% ♥ 5-year mortality = 50%
HFrEF HFpEF
Chronic Heart Failure
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Tests for diagnosis of heart failure
• ECG • Chest X-ray • Echocardiography • Natriretic peptides (BNP) • Blood tests • Exercise test • Cardiac cath.
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Stage A High risk for CHF
No structural heart disease
or CHF symptoms
Stage B Structural heart disease
No CHF symptoms
Stage C Structural heart disease
Prior or current CHF symptoms
Stage D Refractory CHF
requiring special interventions
ACC / AHA Guidelines
Stages in the development of HF and recommended therapy by stage.
Clyde W. Yancy et al. Circulation. 2013;128:e240-e327
Copyright © American Heart Association, Inc. All rights reserved.
Management
Treatment: General Measures
Fluid Status
Non-Compensated Compensated
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Management: Devices ♥ ICD implantable cardioverter-
defibrillator ♥ Cardiac resynchronisation therapy
Resynchronization Therapy For Heart Failure
• Methods: – Epicardial Approach
• Requires thoracotomy • Associated morbidity
– Transvenous Approach • As practical established • Requires access to the
coronary sinus • Requires leads
developed for LV application
Goal: Pace Right and Left Ventricles
Venogram Image of Cardiac Venous System
Lead V3
-------Therapy OFF------- ---------Therapy ON---------
QRS=160 ms QRS=120 ms
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F. Ruschiztka PCHF Course 2015
Conclusions • CHF is a very serious condition with a bad prognosis • Diagnosis of CHF is based on objective evidence of
cardiac dysfunction • Symptoms as well as prognosis can be improved by
appropriate therapy • ACE inhibitors and β-blockers are very well documented
and should be considered in all patients to improve survival, hospitalisation rates and QOL
• Dose levels should be titrated as in clinical trials to achieve maximum benefits
• Devices!