Update in Heart Failure Management Disclosures

Update in Heart Failure Management Definition and Stages “The inability of the heart to meet the metabolic demands of the body”Update in Heart Failure Management Definition and Stages “The inability of the heart to meet the metabolic demands of the body”Update in Heart Failure Management Definition and Stages “The inability of the heart to meet the metabolic demands of the body”

Casey Culbertson MD

Cardiology Medical Director

GE Healthcare Co-Founder MD1World MD1WORLD Lecture Series January-February, 2018

Update in Heart Failure ManagementNew guidelines, diagnostics and treatments

Casey Culbertson MD is a Cardiology Medical Director at GE Healthcare

He owns no stock in the company and is not involved in sales of any GE products

((Adreview®)

Update in Heart Failure Management

Disclosures

Update in Heart Failure Management

Definition and Stages

“The inability of the heart to meet the metabolic demands of the body”

Update in Heart Failure Management

Guidelines

Update in Heart Failure Management

Treatment Algorithm

Update in Heart Failure Management

What if patient on maximal Guideline therapy and still symptomatic?

Update in Heart Failure Management

New HF Medication - SHIFT Study and Results

NSR HR > 70 bpm EF < 35%

N=6505

Update in Heart Failure Management

Ivabradine (Corlanor®)Mechanism of Action

Update in Heart Failure Management

New 2016 ACC/AHA/HFSA Guidelines

Update in Heart Failure Management

New HF Medication: PARADIGM-HF Study

N=8399

Update in Heart Failure Management

LCZ 696 (Entresto®) Mechanism of Action

Update in Heart Failure Management

New 2016 ACC/AHA/HFSA Guidelines

Start Entresto instead of ACE/ARB

Update in Heart Failure Management

New Diagnostics for HF – PA Pressure Monitoring

Update in Heart Failure Management

CardioMEMS® PA Pressure Monitoring System

HR PAP CO

Update in Heart Failure Management

“Advanced Warning” about worsening HF -> change in mortality

Update in Heart Failure Management

“Classic” Diagnostic Tests for Heart Failure

Update in Heart Failure Management

Radio-pharmaceutical agent for “prognostic” HF evaluation

Low Risk H/M ratio > 1.6

High Risk H/M ratio < 1.6

Update in Heart Failure Management

Results: A total of 237 subjects (25%) experienced events (median follow-up 17 months) The hazard ratio for H/M 1.60 was 0.40 (p 0.001 ); the hazard ratio for

continuous H/M was 0.22 (p 0.001) Two-year event rate was 15% for H/M >1.60 and 37% for H/M <1.60; hazard ratios for individual event categories were as follows:

HF progression, 0.49 (p 0.002); arrhythmic events, 0.37 (p 0.02); and cardiac death, 0.14 (p 0.006)

Update in Heart Failure Management

Radionuclide agent for “prognostic” HF evaluation-examples

Update in Heart Failure Management

I 123 IBG Scan to guide Cardiac Resynchronization Therapy (CRT)

Update in Heart Failure Management

Cardiac Resynchronization Therapy (CRT)

Results of Adreview® Scan

Update in Heart Failure Management

Cardiac Resynchronization Therapy (CRT) – Lead Placement

Update in Heart Failure Management

Cardiac Resynchronization Therapy (CRT)-Outcomes

Update in Heart Failure Management

I 123 IBG Scan to guide ICD Placement

ADMIRE-ICD Recruiting now

Thank You for your Attention

Update in Heart Failure Management