心力衰竭管理发展历程
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• Initiate spironolactone first followed by digoxin, boБайду номын сангаасh at a low dose and then up-titrate, check tolerability and blood chemistry.
a
7
Age-related prevalence of CHF
a
8
a
9
American National HF project 34,587 hospitalized patients
Age (median, yrs)
73
Gender (female, %)
59%
History (%) hypertension coronary artery disease diabetes COPD atrial fibrillation
a
13
Drug therapy
• STEP 2 • Initiate first-line therapy in all patients with heart failure due to LVSD with
• a diuretic and an ACE inhibitor for NYHA class I-IV, and
3
• Changing views of heart failure
– 1. A clinical syndrome – 2. A circulatory disorder – 3. Altered architecture of the heart – 4. Abnormal hemodynamics – 5. Disordered fluid balance – 6. Biochemical abnormalities – 7. Maladaptive hypertrophy – 8. Genomics – 9. Epigenetics (实验胚胎学)
Management of Heart Failure:
Past, Present and Future
Lexin Wang, M.D., Ph.D., FCSANZ Professor of Clinical Pharmacology
Head, Cardiovascular Research
a
1
Objectives
a
4
Changing management of heart failure over the past 40 years
Katz, A. M. Circ Heart Fail 2008;1:63-71
a
5
CHF-Prevalence
• Approximately 5.5 million Americans have CHF (2.2% of the population)
61% 56% 38% 33% 30%
Havranek EP et al. Am Heart J 2002;143:412-417
a
10
Classification of CHF
• Systolic CHF
– Weakened ability of the ventricles to contract
• History and pathogenesis • Epidemiology and risk factors • Current management • Future directions
a
2
William Harvey, 1628
Katz, A. M. Circ Heart Fail 20a08;1:63-71
• 2% of adult population • Approximately 241,000 patients • 30,000 new cases each year • 42,000 hospitalisations in 2004-2005
– Accounts for 0.8% of all hospitalisations in the country
• Accounts 40% of all CHF
a
11
Management of CHF
– Life style changes – Pharmacological – Surgical
• Devices • CABG, PCI • Cardiac transplantation
a
12
Drug therapy
• a beta-blocker for NYHA class II-III, unless these are contra-indicated
a
14
Drug therapy
• STEP 3 • Initiate second-line therapy in patients with persistent signs and symptoms of heart failure (NYHA class III/IV) with spironolactone and digoxin
• STEP 1 Confirm left ventricular systolic dysfunction (LVSD) by
• Echocardiography • Radionuclide ventriculography, or • Radiological left ventricular angiography
• Heart failure with preserved systolic function
– Impaired diastolic filling of the left ventricle, resulting in high filling pressure, with or without systolic dysfunction
• 550,000 new cases annually • Accounts for 12 million clinic visits per year • Estimated health care costs in 2004 is US $28.8
billion
a
6
CHF prevalence- Australia
a
7
Age-related prevalence of CHF
a
8
a
9
American National HF project 34,587 hospitalized patients
Age (median, yrs)
73
Gender (female, %)
59%
History (%) hypertension coronary artery disease diabetes COPD atrial fibrillation
a
13
Drug therapy
• STEP 2 • Initiate first-line therapy in all patients with heart failure due to LVSD with
• a diuretic and an ACE inhibitor for NYHA class I-IV, and
3
• Changing views of heart failure
– 1. A clinical syndrome – 2. A circulatory disorder – 3. Altered architecture of the heart – 4. Abnormal hemodynamics – 5. Disordered fluid balance – 6. Biochemical abnormalities – 7. Maladaptive hypertrophy – 8. Genomics – 9. Epigenetics (实验胚胎学)
Management of Heart Failure:
Past, Present and Future
Lexin Wang, M.D., Ph.D., FCSANZ Professor of Clinical Pharmacology
Head, Cardiovascular Research
a
1
Objectives
a
4
Changing management of heart failure over the past 40 years
Katz, A. M. Circ Heart Fail 2008;1:63-71
a
5
CHF-Prevalence
• Approximately 5.5 million Americans have CHF (2.2% of the population)
61% 56% 38% 33% 30%
Havranek EP et al. Am Heart J 2002;143:412-417
a
10
Classification of CHF
• Systolic CHF
– Weakened ability of the ventricles to contract
• History and pathogenesis • Epidemiology and risk factors • Current management • Future directions
a
2
William Harvey, 1628
Katz, A. M. Circ Heart Fail 20a08;1:63-71
• 2% of adult population • Approximately 241,000 patients • 30,000 new cases each year • 42,000 hospitalisations in 2004-2005
– Accounts for 0.8% of all hospitalisations in the country
• Accounts 40% of all CHF
a
11
Management of CHF
– Life style changes – Pharmacological – Surgical
• Devices • CABG, PCI • Cardiac transplantation
a
12
Drug therapy
• a beta-blocker for NYHA class II-III, unless these are contra-indicated
a
14
Drug therapy
• STEP 3 • Initiate second-line therapy in patients with persistent signs and symptoms of heart failure (NYHA class III/IV) with spironolactone and digoxin
• STEP 1 Confirm left ventricular systolic dysfunction (LVSD) by
• Echocardiography • Radionuclide ventriculography, or • Radiological left ventricular angiography
• Heart failure with preserved systolic function
– Impaired diastolic filling of the left ventricle, resulting in high filling pressure, with or without systolic dysfunction
• 550,000 new cases annually • Accounts for 12 million clinic visits per year • Estimated health care costs in 2004 is US $28.8
billion
a
6
CHF prevalence- Australia