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Management of Heart Failure 24-07-2024

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Nakayenga Grace Gladys
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133 views30 pages

Management of Heart Failure 24-07-2024

Uploaded by

Nakayenga Grace Gladys
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HEART FAILURE.

The I cant breath, swell, heart beats faster,

disease
Dr. Stella Nabirye
1
Definition

❑ Heart failure: a complex clinical syndrome with current or


prior symptoms and signs caused by structural and or
functional cardiac abnormalities and either:

❑ Elevated natriuretic peptide concentrations

❑ Or objective evidence of cardiogenic, pulmonary, or


systemic congestion

❑ HFrEF: Heart failure with an EF of <40%


2
Universal definition

3
Epidemiology
Although the etiology of HfrEF differs from HFpEF, there is an overlap in
the etiology of both

In industrialized countries CAD is the predominant etiology in men &


women (60% &75%)

HTN – African and African American population


RHD is a major cause of HF in Africa and Asia-Young
Chagas disease-major cause of HF in south America

HF in developing countries is becoming similar to that Western Europe


& North America , With CAD emerging as single most common
cause of HF
4
Types of heart failure

5
Systolic and diastolic dysfunction

6
Trajectory of heart failure

7
Stages of heart failure

8
Risk Ischemic heart disease, myocardial
factors infarction, myocarditis, tachycardia,
hypertension

Diabetes mellitus, structural heart


disease related to congenital heart
disease, sleep apnoea,

Drug or alcohol use, obesity,


Drugs like NSAIDS/chemotherapy 9

increase risk of HF
Pathophysiology

10
11
Responsibility
at a young
age

12
13
Cxray findings

14
Precipitating factors
Arrythmias - Tachycardia or bradycardia
Infections, alcohol,
anemia
Medications that • CCBs( verapamil/diltiazem)
worsen heart failure Thiazolidinediones
• B-blockers, anti-TNF antibodies
• Antiarrhythmic agents(class I agents,
sotalol)
NSAIDS
Dietary indiscretion Myocardial infarction, pregnancy,
Inappropriate Worsening hypertension, acute valvular
reduction in insufficiency
15
HFmedications
Guideline–Directed Medical Management of Heart Failure
with Reduced Ejection Fraction

16
17
Stage C

18
19
Double blind randomized control
trial
Addition of enalapril to
conventional therapy
significantly reduced
mortality and hospitalization
in patients with chronic HFrEF
At 26% reduction

20
● Double-blind multi-center RCT

○ RX-Candesartan +/- ACEI

○ Enrolled NYHA II-IV CHF/ LVEF <40%


into candesartan or placebo group
in 2 complementary parallel trials

○ 2289 candesartan, 2287-placebo

● Conc: Candesartan significantly reduces


all cause-mortality, CV death, and heart
failure hospitalization in CHF and
LVEF<40% when added to standard
therapy 21
Target dose in the trial was 97/103 of
sac-val
ACC/AHA/HFSA don’t recommend
starting HFrEF patients on ARNI in
those with chronic HFrEF, NYHA II /III,
and tolerating ACEI or ARB
Primary endpoint: CV death or
hospitalization for heart failure.
ARNI recommended as a replacement
to further reduce morbidity and
mortality (class I indication)
Side effects
Hypotension(14%), hyperkalemia (4%)
cough(11%)
For patients who are switching from
ACEI to ARNI, at least withhold ACEIs
for 36 hours before switching to
ARNI
22
23
A double-blind RCT study
1663 patients enrolled, (had
severe heart failure, EF <35)
822 received spironolactone and
841 received placebo
Mean follow-up period-
24months
Primary endpoint was death
from any cause

Conclusion: spironolactone
reduced mortality and
symptoms in NYHA 3+, (RR-
30% 24
Meta analysis of 2 single large SGLT2 inhibition
scale trials to assess SGLT2 IN 26% RR in combined risk of CV death or
1st hospitalization for heart failure
HFrEF
25% decrease in composite of recurrent
hospitalizations for heart failure or CV
Primary end point-time to all death
cause mortality
❑Both DAPA-HF –(dapagliflozin) and
Among 8474 pats from both trials, EMPEROR-Reduced (empagliflozin)
estimated RX was 13% reduction trials showed SGLT2 inhibitors reduced
in all-cause death, 14% combined risk of CV death
reduction in CV death /hospitalization in HFrEF with or without
DM 25
Ivabradine

26
Patients LVEF<45%, in addition to
Diuretics, ACEIs
3397-digoxin, 3403-placebo
Results:
34.8% death in dig compared to 35.1%
placebo
6% fewer hospitalization in Dig gp

❑ Concl: Dig did not reduce


mortality but a reduced rate of
hospitalization overall &
worsening HF.
27
—Someone Famous.

28
29
Thanks

30

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