Suy tim mất bù cấp những bằng chứng và những hướng nghiên cứu mới

SUY TIM MẤT BÙ CẤP: NHỮNG BẰNG CHỨNG VÀ NHỮNG HƯỚNG NGHIÊN CỨU MỚI Hội nghị Tim Mạch Quốc Gia Việt nam - Đà Nẵng 10-2014 TS..  “Warm and wet” • Continue treatment, no change in dosage

SUY TIM MẤT BÙ CẤP: NHỮNG BẰNG CHỨNG

VÀ NHỮNG HƯỚNG NGHIÊN CỨU MỚI

Hội nghị Tim Mạch Quốc Gia Việt nam - Đà Nẵng 10-2014

TS NGUYỄN THỊ THU HOÀI

VIỆN TIM MẠCH QUỐC GIA VIỆT NAM

DIURETIC

What to Do with Beta-Blockers?

 “Warm and wet”

• Continue treatment, no change in dosage

 “Cold and wet”

• Decrease dose by 50% or hold until

end-organ perfusion is achieved

 “Warm and dry”

• Initiate therapy as in-patient

• Shorter hospital stays, improved survival

• During follow-up more patients tend to be on the drug

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CÁC THUỐC ĐANG ĐƯỢC NGHIÊN CỨU

Rolofylline:

- Adenosine A1 receptor antagonist

- Studied in the setting of ADHF and renal

impairment

+ Preserve GFR

+ Improve the response to diuretic therapy

+ Increase sodium excretion by blocking the

effects of adenosine on the kidney

(Phase III)

+ Promotes renal blood flow

+ Increases vascular endothelial growth factor and angiogenesis

Omecamtiv mecarbil:

The first selective cardiac myosin activator to be studied in

humans Through greater binding of myosin to actin during cardiac systole, omecamtiv mecarbil increases the force of myocardial

contractions without increasing myocardial oxygen consumption

Ularitide:

A synthetic form of urodilatin, a human natriuretic peptide,

produced in the kidneys It induces natriuresis and diuresis by

binding to specific natriuretic

peptide receptors (NPR-A, NPR-B, and others)

ULTRAFILTRATION

 May be considered instead of diuretics for treating volume

overload in the setting of ADHF

(strength of evidence B, HFSA 2010 guidelines)

 Issues related to venous access, systemic anticoagulation and bleeding risks, and acute kidney injury need to be explored in

larger patient cohorts

 Patients with ADHF who are truly refractory to diuretic therapy also deserve further study

QUALITY OF CARE

 Education: patient- focused education

 Self-care: self-management strategies

 Discharge planning: early follow-up (7 days) -> lower rate of readmission within 30 days

 Medication support

QUALITY OF CARE

1) Ongoing contact with a care manager and interactions

before and after discharge

2) Education that includes assuring understanding of

content and comprehensive discharge planning, including early follow-up and medication reconciliation and

adherence

3) Access to community resources

4) Provider-to-provider communication and coordination

PROCESS OF CARE IN THE HOSPITAL SETTING

Developing standard algorithms and processes to rapidly assess and implement early therapy in patients in prehospital and ED-based settings

(ambulance, ED, or observation units)

Collaborations among prehospital personnel, cardiologists, hospital-based clinicians, heart failure specialists, and

emergency physicians are needed to ensure a smooth

transition of care

Summary

reduced and preserved left ventricular

function

more renal insufficiency

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Summary

strategies, vasodilator therapies, and

ultrafiltration

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XIN CHÂN THÀNH CẢM ƠN!