Acute Heart Failure ICU to the Regular Ward

Mihai Gheorghiade MD, FACCProfessor of Medicine and Surgery

Director of Experimental TherapeuticsCenter for Cardiovascular Innovation

Northwestern University Feinberg School of Medicine, Chicago, Illinois

Conflict of Interest Conflict of Interest

Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma AG, Cardiorentis Ltd, CorThera, Cytokinetics, CytoPherx, Inc, DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Intersection Medical, INC, Johnson & Johnson, Medtronic, Merck, Novartis Pharma AG, Ono Parmaceuticals USA, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, Sanofi-Aventis, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT,Takeda Pharmaceuticals North America, Inc and Trevena Therapeutics; and has received signficant (> $10,000) support from Bayer Schering Pharma AG, DebioPharm S.A., Medtronic,Novartis Pharma AG, Otsuka Pharmaceuticals, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT and Takeda Pharmaceuticals North America, Inc.

• Millions of patients are hospitalized with HF (80% have chronic HF).

• Majority are hypertensive or normotensive at presentation.

• Vast majority improve with diuretic therapy and discharged with minimum signs and symptoms.

• Despite robust in-hospital improvement and provision of guideline direct therapy, post-discharge mortality and hospitalization are as high as 15% and 30%, respectively, within 60 to 90 days post-discharge.

• Approximately 50% of patients have preserved EF for which there are no evidence-based therapies.

• Post-discharge event rate has not changed in the last 15 years.

ACUTE HEAR FAILUREACUTE HEAR FAILUREThe The Unmet NeedUnmet Need

Worsening Chronic Heart Failure: The Major Reason for HF

HospitalizationsWorsening chronic

heart failure (75%)

De novo heartfailure (23%)

Advanced/ end-stageheart failure(2%)

Fonarow GC. Rev Cardiovasc Med. 2003; 4 (Suppl. 7): 21Cleland JG et al. Eur Heart J. 2003; 24: 442

Characteristics of Hospitalized Heart Failure (HHF) Patients

Median age (years) 75 Atrial Fibrillation 40%

Women >50% Renal abnormalities 30%

Hx of CAD 60% SBP >140 mm Hg 50%

Hx of Hypertension 70% SBP 90-140 mm Hg 45%

Hx of Diabetes 40% SBP <90 mm Hg 5%

.

Data on approximately 200,000 patients

Gheorghiade and Braunwald JAMA 2011

Prognosis Following HospitalizationEVEREST - HHF TRILOGY - ACS

Both registries and clinical trials highlight the unmet need in new therapies for patients hospitalized for heart failure.

88%

6% 6%10%

3% 1%10%

Most Common IV Medications

ICU Pre-Discharge Assessment

• Physical exam (HR, rhythm, BP)• Laboratory data (renal function, serum

sodium, BNP, troponin)

Conclusions

• Majority of patients admitted with HF responds to standard therapy and do not need ICU stay

• Need to develop criteria for ICU admissions and discharge