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

03.10.18

Tests for diagnosis of heart failure

•  ECG •  Chest X-ray •  Echocardiography •  Natriretic peptides (BNP) •  Blood tests •  Exercise test •  Cardiac cath.

03.10.18

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

03.10.18

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

03.10.18

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!