Heart Failure Mngt
Summary
TLDRThe lecture discusses the potential complication of Covid-19 leading to heart failure, outlining its definitions, causes, and impact on patients. It differentiates between heart failure with reduced and preserved ejection fraction, emphasizing the importance of ejection fraction in diagnosis. The talk highlights clinical studies on medications like sacubitril/valsartan for heart failure management, showcasing their benefits in reducing hospitalization and cardiovascular death. It also addresses the significance of early diagnosis and treatment, the role of heart failure clinics in outpatient care, and considerations for patients with comorbidities like CKD.
Takeaways
- 📚 The lecture provides an in-depth understanding of heart failure, its complications, and the transition from hospital to outpatient care.
- 🔍 Heart failure is defined by the European Society of Cardiology as an abnormality leading to the heart's inability to deliver oxygen to tissues, despite normal filling pressures.
- 🇪🇺 The American Heart Association adds that heart failure is a complex clinical syndrome resulting from structural or functional impairments of the heart's pumping function.
- 💊 The lecture discusses the significance of ejection fraction (EF) in categorizing heart failure into reduced EF (HFrEF) and preserved EF (HFpEF), with different treatment approaches.
- 🚑 Heart failure is a leading cause of hospitalization, particularly for those over 65, with high rates of readmission and mortality within the first year.
- 🩺 The impact of heart failure on patients includes physical and mental health issues, decreased quality of life, and the risk of sudden cardiac death.
- 🛑 The importance of early and effective management post-hospitalization is emphasized to reduce the risk of readmission and improve outcomes.
- 💡 The PARADIGM-HF study highlights the benefits of sacubitril/valsartan over enalapril in reducing cardiovascular death and heart failure hospitalization.
- 📈 The PIONEER and TRANSITION studies support the initiation of sacubitril/valsartan in hospitalized patients with reduced ejection fraction heart failure, showing improved outcomes and tolerability.
- 🏥 The establishment of a Heart Failure Clinic is presented as a strategy to bridge the gap between in-hospital and outpatient care, optimizing management and reducing hospital readmissions.
- 📊 The ongoing study by Dr. Katarina Modovar aims to assess the clinical profile of patients in the Heart Failure Clinic, providing insights into the demographics and treatment of heart failure patients.
Q & A
What is the definition of heart failure according to the European Society of Cardiology?
-Heart failure is defined as an abnormality of cardiac structure or function, leading to the heart's failure to deliver oxygen at the recommensurate requirements of the metabolizing tissues despite normal filling pressures.
How does the American Heart Association define heart failure?
-The American Heart Association defines heart failure as a complex clinical syndrome that results from any structural or functional impairment of the heart's ability to relax or eject blood.
What does HFrEF stand for and what does it indicate?
-HFrEF stands for Heart Failure with Reduced Ejection Fraction, indicating a condition where the left ventricular ejection fraction is less than or close to 35-40%.
What is the difference between HFrEF and HFpEF?
-HFrEF refers to heart failure with reduced ejection fraction, while HFpEF, or heart failure with preserved ejection fraction, indicates a condition where the ejection function is more than 40%, also known as diastolic dysfunction.
What are the main causes of heart failure?
-The main causes of heart failure include coronary artery disease, valvular heart disease, cardiomyopathies, and other conditions such as hypertension and diabetes.
How does heart failure impact patients physically and mentally?
-Heart failure can cause physical problems such as shortness of breath and fatigue, and it is associated with mental issues like depression, affecting about 1/3 of patients.
What is the significance of ejection fraction in heart failure management?
-Ejection fraction is the amount of blood pumped out of the ventricle over the total amount of blood in the ventricle. It helps in determining the severity of heart failure and guides treatment strategies.
What are the clinical outcomes for patients with heart failure within the first year?
-Within the first year, about 10% of patients may die in the hospital, 50% may be hospitalized, and there is a 30% chance of re-hospitalization within five years.
How do the PARADIGM-HF and PIONEER trials contribute to heart failure treatment?
-The PARADIGM-HF trial showed that sacubitril/valsartan reduced the risk of heart failure hospitalization and cardiovascular death compared to enalapril. The PIONEER trial confirmed the safety and efficacy of initiating sacubitril/valsartan in the hospital setting after hemodynamic stabilization.
What is the role of neprilysin inhibitors in heart failure treatment?
-Neprilysin inhibitors, such as sacubitril, have been shown to reduce the risk of heart failure hospitalization and cardiovascular death, making them an important part of heart failure treatment, especially in patients with reduced ejection fraction.
How does the use of sacubitril/valsartan affect patients with heart failure and preserved ejection fraction (HFpEF)?
-While the trials primarily focused on patients with reduced ejection fraction, some clinicians may still consider using sacubitril/valsartan in HFpEF patients, especially if they present with significant heart failure symptoms.
Should sacubitril/valsartan be discontinued if a patient's ejection fraction improves?
-There is no study suggesting that sacubitril/valsartan should be discontinued after achieving a target ejection fraction. In fact, if a patient responds well to the medication, it should be continued.
How is sacubitril/valsartan used in patients with chronic kidney disease (CKD)?
-For patients with moderate CKD, the full dose of sacubitril/valsartan (200 mg twice daily) can be used. For those with severe CKD (eGFR less than 30), a lower dose of 50 mg twice daily is recommended.
What are the considerations for initiating sacubitril/valsartan in patients hospitalized with heart failure?
-Initiation of sacubitril/valsartan in hospitalized patients with heart failure may be considered when they are hemodynamically stabilized and have a left ventricular ejection fraction less than 40%.
Outlines
😷 Introduction to Heart Failure Management
The lecture begins with an introduction to the potential complications of Covid-19, specifically heart failure. The speaker defines heart failure according to the European Society of Cardiology and the American Heart Association, highlighting its impact on the heart's ability to deliver oxygen. The causes of heart failure are discussed, including coronary heart disease, valvular heart disease, cardiomyopathies, and other factors like hypertension and diabetes. The concept of ejection fraction is introduced, explaining its significance in diagnosing heart failure. The speaker also differentiates between chronic and acute heart failure, emphasizing the urgency of treatment for acute cases.
🏥 Clinical Outcomes and Hospitalization Rates
This paragraph delves into the clinical outcomes of heart failure patients, noting that sudden cardiac death is a common cause of mortality. Statistics on hospitalization rates and mortality within the first 90 days are presented, with 10% in-hospital mortality and 50% re-hospitalization rates. The five-year survival rate for heart failure patients is compared to the general population, highlighting the stark contrast. The importance of managing heart failure patients during the vulnerable period post-hospitalization is emphasized, with a focus on optimizing treatment to reduce re-hospitalization rates.
💊 Paradigm Heart Failure Studies and Medication Management
The speaker discusses the Paradigm Heart Failure Study, which investigates the effects of sacubitril/valsartan and beta-blockers in heart failure management. The study results show a 20% relative risk reduction in heart failure hospitalization and a 21% reduction in the first heart failure hospitalization. The use of neprilysin inhibitors (like sacubitril) is compared to ACE inhibitors, particularly inalapril, demonstrating the potential for better outcomes. The importance of administering baseline drugs during hospitalization, including ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists, is highlighted.
🔬 Pioneer and Transition Studies on Heart Failure Treatment
The Pioneer and Transition studies are discussed, focusing on the use of sacubitril/valsartan in hospitalized patients with heart failure. These studies aim to determine the effectiveness of initiating sacubitril/valsartan before discharge or shortly after stabilization. The studies involve patients with reduced ejection fraction and compare the use of sacubitril/valsartan with ACE inhibitors. The results show that sacubitril/valsartan can be safely initiated in a wide range of patients and is well-tolerated, with a significant reduction in heart failure admissions within 30 days.
🏥 Predictors of Successful Sacubitril/Valsartan Therapy
This paragraph explores the factors that predict successful sacubitril/valsartan therapy in heart failure patients. It highlights the importance of age, good renal function, stable hemodynamics, and a history of hypertension. The completion rates of the Transition study are discussed, showing comparable proportions of patients achieving the target dose of sacubitril/valsartan in both pre-discharge and post-discharge initiations. The paragraph also notes that adverse events were relatively comparable between groups, indicating the safety of sacubitril/valsartan initiation.
🌐 Regional Heart Failure Clinic and Patient Distribution
The speaker introduces the Heart Failure Clinic at the Regional Training and Teaching Hospital, launched to bridge the gap between in-hospital and outpatient care. Initial results from a study by Dr. Katarina Modovar are shared, showing the clinical profile of patients in the clinic. The distribution of heart failure patients by age, ejection fraction, and etiology is discussed, with coronary artery disease being the most common cause. The geographical distribution of patients is also noted, with most patients coming from Albay province.
💬 Open Forum and Questions on Heart Failure Management
The lecture concludes with an open forum where questions are addressed. The first question discusses the routine request for MT Pro BNP in patients presenting with heart failure symptoms, emphasizing its role in distinguishing cardiac from respiratory origins. The second question explores the impact of cardiac remodeling studies on heart failure patients with preserved ejection fraction. The final question addresses the use of sacubitril/valsartan in patients with CKD or hemodialysis, noting that it can be used with caution and at lower doses for severe CKD patients. The speaker also comments on the cost of sacubitril/valsartan and the availability of programs to assist patients.
Mindmap
Keywords
💡Heart Failure
💡Ejection Fraction
💡Coronary Heart Disease
💡Valvular Heart Disease
💡Cardiomyopathies
💡Acute Heart Failure
💡Chronic Heart Failure
💡Angiotensin-Converting Enzyme (ACE) Inhibitors
💡Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors
💡Diastolic Dysfunction
💡Heart Failure Clinic
Highlights
The lecture discusses the potential complication of Covid-19 virus leading to heart failure.
Heart failure is defined by the European Society of Cardiology as an abnormality leading to the heart's inability to deliver oxygen to tissues despite normal filling pressures.
American Heart Association describes heart failure as a complex clinical syndrome resulting from structural or functional impairment of the heart.
Heart failure types include reduced ejection fraction (HEF) and preserved ejection fraction (PEF), with different clinical implications.
Ejection fraction is the amount of blood pumped out of the ventricle, which is a key indicator in diagnosing heart failure.
Common causes of heart failure include coronary artery disease, valvular heart disease, and cardiomyopathies.
Heart failure impacts patients physically and mentally, often leading to depression and decreased quality of life.
Heart failure is a progressive syndrome with a high rate of repeat hospitalizations and risk of sudden cardiac death.
Clinical outcomes for heart failure patients are poor, with high in-hospital mortality rates and frequent rehospitalizations.
Registries show contrasting survival rates for heart failure patients compared to the general population.
Heart failure is a leading cause of hospitalization for patients over 65, with high readmission rates.
The PARADIGM-HF study showed a 20% relative risk reduction in heart failure hospitalization with sacubitril/valsartan compared to enalapril.
PIONEER and TRANSITION studies complement each other, focusing on the use of sacubitril/valsartan in hospitalized patients with heart failure.
The PIONEER study demonstrated the superiority of sacubitril/valsartan in reducing NT-proBNP levels, a marker for heart failure severity.
TRANSITION study aimed to measure the proportion of patients achieving the target dose of sacubitril/valsartan after discharge.
Initiation of sacubitril/valsartan shortly after an acute compensated heart failure event is feasible and well-tolerated.
Heart failure management has been optimized through the establishment of a Heart Failure Clinic to bridge in-hospital to outpatient care.
An initial study on the Heart Failure Clinic's patient profile showed a majority with reduced ejection fraction and common etiologies such as coronary artery disease.
The use of sacubitril/valsartan in patients with heart failure has been endorsed by major cardiology societies for its benefits in reducing cardiovascular mortality.
Discontinuation of sacubitril/valsartan is not recommended even if there is an improvement in ejection fraction, as it has shown positive responses.
The cost of sacubitril/valsartan is considered high, but patient assistance programs are available to help with affordability.
Transcripts
okay so
after the very comprehensive lecture on Covid 19 virus
no so
we come now to a very potential side effect
or complication of the Covid virus
which is heart failure
but of course that remains to be the same
so the title of tonight's module is Heart Failure
Management
Reaching in Hospital Initiation to Outpatient Care
so
let me first give you the definitions of heart failure
so according to the European Society of cardiology
this is
an abnormality of cardiac structure or function
leading to failure of the heart to deliver oxygen
at the recommensurate
requirements of the metabolising tissues
despite normal feeling pressures
on the other hand American Heart Association or a C C H
a give the definition that this is a complex
clinical syndrome that results from any structural
or functional impairment of the particular feeling or
ejection of blood
so what are them now the causes of heart failure
so this is a complex clinical syndrome
which is an interplay of the different oil uh
parts of the heart
so which are the great vessels and ocardium
myocardium and pericardium of course
so for some of my lectures
so we may have heard of half ref
half deaf C H F or E H F so what does this stand for
so your half breath is
stands for your reduced ejection fraction
heart failure wherein your left
particular ejection fraction is less than
or close to 35 to 40% half bath
on the other
hand is a heart failure with reserve ejection fraction
so many to say
they have an ejection function more than 40% more
so this is called also your diastolic dysfunction
see
each therefore stand for your chronic heart failure
which is a persistent and progressive heart failure
following a relaxing and remeding course
and your acute heart failure
means there is a rapid
on set
for change in the signs and symptoms of heart failure
a life threatening situation
which for
which requires urgent therapy or hospitalization
so what is meant by ejection fraction
because that is what we always want to hear
from our duty equity point
so ejection fraction is uh
uh is amount of blood pumped out of the ventricle
and over that
of the total amount of blood in the ventricle
from there you get your ejection fraction
so that's where we are
delineate your present ejection fraction
or reduce the ejection fraction
with regards to the causes of heart failure
of course the most common or the most common uh
cause of your heart failure
steal your coronary heart disease
then the rest is evaluated to valvular heart disease
cardiomayopathies and of course others water
valvular diseases
and some associated hypertension and diabetes
for your half birth
which is commonly known as your diastolic dysfunction
so this is what we always explain to our patients
maybe which is
a problem or environment
in the ventricular relaxation of the myocardium
which is an active process increased
ventricular stiffness
often encountered with elderly individuals
value leg diseases can also cause her health birth
as well as her constructive pericarditis
most commonly brought about
tuberculosis
and some of this for acute my vagal s failure
so what is important is to know
the impact of heart failure on patients
so maybe these are the four
very important aspects of the impact of heart failure
No. 1 it can cause physical and mental problems
uh as my my not others know
uh about 1/3 of these patients would always feel uh
low mood or uh depression
in the third
some complain of decreasing your quality of life
because of resistant
shortness of breath and easy fatigability
so heart failure
is often a progressive syndrome with complex
commodities resulting in repeat hospitalization
so the degree of the treatment
uh that we are implementing to patients
it's almost dependent on the
percentage of three hospitalizations of this patient
and of course
we do not want our patient to develop sudden cardiac
death which is the most common cause
of death in people with mild to moderate heart failure
so with regards to clinical outcomes
here are some facts and so almost 10%
develop in hospital mortality
during the first 90 days
or three months of the patient
50% obvious
patients would be hospitalized during the 90 days
but one year there is a 30% chance
that the patient might be re hospitalized
in the next five years there is a greater
percentage of mortality for these patients
that's the clinical impact of heart failure
now basing on these registries
so it was said
so this is a general practitioner registry okay
so five year survival rate
for heart failure patients is at 58%
however another registry will show to us that
with regards to age and sex
much general population there is 93% uh survivor rate
so
we can see from these figures that there are varying uh
there's a contrasting uh degree of uh registries
so
why is now under 30 days
of those patients with heart failure
initially diagnosed
very important it is because of this
so heart failure is
one of the most common causes of hospitalization
for patients aged more than 65 years
so about half of these patients are still being re
admitted after discharge
since during the first year of their course
now in the US alone
the 30 daily admission rate is almost 25%
and in Europe sorry admission rates are 25
34% at 12 weeks
so we might want to catch this patient on
the vulnerable face after hospitalisation
so it is on this vulnerable face
that we would want to optimise our management
for heart failure patients
okay so
we always know that most of this would eventually
go through your chronic heart failure
so do not want this
because mortality during the 30 day period is 10%
so this a very important slide
because most of the patients now being discharged
in fact
I've been administered already the uh uh baseline drugs
nuduring uh
their admission
which includes your ace inhibitor or ARB beta blocker
aldustaran antagonist of course
your nitrates
and some of them will be given antiquotulants
so moving on
so this was the uh paradigm heart failure study
so today the paradigm heart failure studies
are very large studies
we're in it in to see the effect uh
if sakubitrial
balsatan and Casto could replace an asinhibitor
particularly your inal Aprill
so why inal aprill because
inal Aprill is still the widely used as inhibitor
and the most studied is inhibitor when it comes to
heart failure management okay
so uh both of these were compared
so what was the results so
the results showed solar study outcomes for primary
composite outcomes
so cardiovascular death or hospitalization
the city death or first event
or are heart failure hospitalisation as first event
as well as your dad from CV
process or heart failure hospitalisation
so it showed that societal Vassar can interest
though showed
a 20% relative risk reduction
in heart failure hospitalisation
as well as CBD as a first event versus your
in other prayer
so furthermore
there was a 21% relative risk production
in the first heart failure hospitalization
so remember that during the first 30 days
this is what we want to avoid okay
so first heart hospitalization in January
the chronic phase so
we would not want our patients to go into
cardiovascular death
so the paradigm
Mark failure study
showed that there was 20% relative risk reduction
with regards to your cardiovascular death
so during the 30 day use
also of each of occipital valcytan
so there was a
38% relative risk production in the 30 day hospital uh
heart failure admissions
and so which which is quite very significant
so apart from the Biodynam heart failure study
so concerning your occupital valscite and interest
though so the pioneer
it's uh there
it stand up into a pioneer heart failure trial
and transition studies so
both the pioneer
and transition studies complement each other
okay so this is with regards to the use of your uh
circulated vasor done initiation
uh for in hospital patients are free discharge
so it aim to know uh the following
so it's stabilized following and acute
the compensated heart failure
pre existing or nearly diagnosed heart failure
and on any ace inhibitor or ARB dose before admission
or an ace inhibitor Arbina is
okay so this is what I was talking about
so these two studies complement each other
okay so for the Baunia heart failure
so uh it was compared with your ace inhibitorinaloprel
okay as a free discharge initiation
so while with the transition study
so it aim to measure the proportion of patients
achieving a target dose of 200 mg
and Tristol PID 10 weeks after the randomization
so on the transition studies
the primary
objective was to evaluate the proportion of patients
with the
target dose of interest to 200 mg AIP at week 10
post randomization in the pre and post discharge
so remember and also
why is it very much important
in the pre and post discharge
because it is at this stage we're in
we want to optimise our heart failure management
so there are India
you understand we expose randomization
so the key inclusion criteria as follows also
of important to know is that the LV
ejection fraction
should be lower than 40% at screening
so the Niha classification
divided between class 2 to class 4
so it was evenly distributed around the world
so in fact they had 150 sites for these studies
so 90 countries participated in the study
so the study design was as follows
so there was randomisation to pre oppose discharge a
so uh it was subdivided in the three strata
and so you have your A'S plus 0 m t
0 o m t is optimal medical therapy
a R B+ o m t and o m t
but a C inhibitor or a r d na a of patients okay
so Intrasto was started at the low dose
and update rated to a maximum dose of 200 mg b I d
so
the baseline characteristics for patients in the pre
discharge and post discharge were almost similar
but of course
important to note is that in the transition study
most of your patients are older
and have more severe heart failure symptoms okay
so you should always remember this one
so why is it important
so this would mean that most of these patients in fact
could have been in the acute
they compensated heart failure stable
so that's why uh they had this heart failure symptoms
so moving on so
most of these patients also have relatively
more comorbidities compared with the previous study
so what did it show so the primary end point
so the target dose of interested 200 mg
the I d dosing was a chill okay
as well as secondary end point
now we're in the Aah interest
that was maximized up to 200 mg
b a d reaching up to 10 weeks
and then with regards to the adverse events
so almost the same
now for the previous church and postist church uh
structure but none of them reached the 5% cut off
so adverse events were relatively compatible
on both groups
made on the previous church and post this church
so what could be that
predictors for successful interest or apetration
so maybe you would want to take a look at this one
so most of these patients uh
relatively uh belong to the 65 years of age
of course they should show a good gfr at this line
stable chemodynamics
as well as those patients with history of hypertension
so uh with regards to their outcome
so it did not vary or it did not change
me in a pre discharge or post discharge on
so
the completions of the transition study were as files
uh showed comparable proportions of patients
met the primary and secondary and coin
in the pre and post discharge initiations
so about half of patients with half ref
or reduce ejection fraction
stabilised after an acute
compensated heart failure event
achieve the target dose of 200 milligrams
uh b I d
within 10 weeks
so more than 86% of patients in both groups
receiving any dose for two weeks or longer
without interruption
now the adverse events comparing your interest though
no we are pre and post discharged in that value at all
so initiation of interest
though in a wide range of patients with half breath
shortly after an acute
they compensated heart failure in the
in hospital or shortly after discharge was visible
and overall well tolerated
so moving on with the pioneer study
so the study and points of this study was the time
average
proportional change in antiprophy and concentration
from baseline through weeks 4 to 8
it also aimed to Aah
look into the safety profile of Aah circuit
with a certain interest
so this was an eight week study
again comparing your circular
vulciartan interest versus your 10 milligram
in alope Vera twice daily marker
and then evaluate the evaluated biomarker
sort of its of efficacy
as well as the safety and tolerability
and clinical outcomes so
here are the key clinical criteria
for the pioneer study
so important to note again that uh patients
enrolled in the study were stabilized first in moderna
mentally okay
so we need to say uh
the systemic blood pressure
should be more than 100 millimeter mercury
without the use of any iron tubes at all
as well as your vasodilators
so study dose hydration so uh
those of the interest though was escalated
uh depending on their uh hemodynamic status
so the target dose was to reach the 200 milligram dose
the ID of your interest though or your inner level
10 milligrams
twice daily dosy so again
the baseline characteristics for both arms
so were pretty similar so important to know
which is a primary end point
is that for those patients on interests
or relatively
show that much degree reduction in your NB Pro
BNP from your days night
so for the information of everyone
so your NP Pro BNP is a sort of get marker
uh for your uh severity of your heart failure
to me to see the higher it is now
so you would uh assume that uh
the degree of the heart failure of the patients is on
the higher side
so with regards to serious clinical composite endpoint
okay so uh there was less degree of your death
hospitalary hospitalisation
as well as the use of your
left particular assist device
and then the possible need for eye transplantation
so keys of group analysis show that uh
most of the patients now
uh in the intrustal arm show uh better resource
results know with regards to their heart failure
and then with the possible use of your acvator or ERD
now for the safety profile so important uh
so
with regards to the worsening of the renal function
in heartbreak
what is important to notice the possible effect uh
side effect of angiodema
so which is a severe type of hypersensitivity
so
it was only recorded on one patient
and interest though also and I think four in the
this is the conclusions of the pioneer heart failure as
as follows so
this reconfirms the superiority of interest of
over 80 hivatory shown in the paradigm heart failure
now demonstrated in the hospital setting
in a wide range of patients with FFR
okay so
in hospital
initiation of interest are compared with inalapreate
leads to
significant degree and more rapid reduction of your
antipro B&P
so there was severe reduction on your serious uh
clinical outcomes okay
so
the pioneer heart failure reconfirms that in hospital
initiation of interest
though shortly after hemodynamic stabilization
has safety and comparable to inal appeal
so again
your pioneer reconfirms the superiority of interest
though over easy needed or in the hospital setting
so what uh since our title was uh
reaching your in hospital to outpatient care
so what can we do as clinicians okay
so we at B I d d H
were able to come up with the heart failure cleaning
and so which was launched last year so ah
we were able
so far to bridge this cap in the inner hospital
and ovation care
so in fact in the study of Doctor Katarina Modovar
one of the senior residents
so she aimed to look
at the clinical profile of patients in
the Heart Failure Clinic
of Recreational Training and Teaching Hospital
so this was the uh initial study as okay
so here are some pictures of
the launching of the Heart Failure Clinic
at the rtph last year
so the initial results of the study of the coronavirus
show that uh
uh there were 81 total consoles
they saw
we were catching up with the total consoles already
however pandemics uh super strike
so we were we stopped our recruitments
or consultations at the Heart Failure
Clinic since March now
so when the ECQ started they saw ah
okay so with regards to each distribution
so uh most of them belong to the 41 to 60 inch law
so heart failure uh
in the so
the distribution of the heart failure
was still more under reduced ejection fraction okay
so almost 81% of them had
have failed
and only 50 of them had reserved Egyptian fraction
with regards to etiology okay
so still so we were apart
um with uh
sensors which has commonly caused by your
coronary artery disease okay
followed by others
so this would be possibly dilated cardiomyopathy
and then followed by your cellular heart disease
uh sorry and then your cardiomyopathies
so the distribution of patients and so are actually
so since we are catering to the antarctical region
so but most of our patients were still in the
Albi province
so most of them we're in the high organised areas
so in the second district of Albay
so with regards to heart failure symptoms
on this study it showed that uh
patients would still be completing of this fatigability
chest pain and difficulty of breathing
so we are very much excited with the
results of this study
so we are waiting for the final results of this study
so in conclusion
so the pioneer heart failure is complement
are they interested in studies
so uh we need in a transitional paradigm
heart failure studies
so by union
transition studies show that interests can be started
prior to discharge or soon after stabilization
to help keep your patients with half ref home
and of course
better be protected because in this era of pandemic
the covid pandemic
we would not want to see our patients regularly
at our clinics to lessen their exposure
so as much as we want
so we can treat them uh the comfort of their home
so I think it's the last line so I'm sorry
so here are some uh important to share
because
in the European Society of cardiology consensus okay
so initiation of occupital via site
and rather than ace inhibitor or an ARP
may be considered for patients hospitalized
with no answer type failure
or they compensated
heart failure as shown in your paradigm
heart failure child
so the same is true with the
expert consensus of the Heart Failure Association
of America and then the European Society of cardiology
so with that thank you and good evening
okay thank you for Doctor Shockson
for that very informative lecture
so now we will proceed with the open forum
so currently we have two questions here
the first questions the first question is
for a few compensated heart failure
do we routinely request for MT Pro BMC
especially for patients
clinically presenting with heart failure symptoms
okay so
if you want to complete your work out
for your heart failure so ideally an MD
Brody and B should be requested okay
because it is a surrogate marker for your
heart failure diagnosis
but of course in the previous years
so NP Pro
BNP was requested
primarily to distinguish if your symptoms are
uh with regards to cardiac in origin or respiratory in
origin okay
so we need to say
if you yield the higher result of your MP programme
with symptoms of uh
easy fatigability and shortness of breath okay
so maybe you are dealing with cardiac in origin
so how frequently
okay so of course you may do it once only okay
so
to see if you have higher results of your antiprogane
so by the way
each hospital has a cut off for the antipropy NB
so nakita nasha uh during a practice
so there's a cut off for acute heart failure
and then chronic heart failure
and then the third one would be uh
belongshare than the cut of levels
who are dealing more with a respiratory origin
so the next is comment from Doctor Salasar
very informative discussion
doctor armies have shown to be superior to other meds
such as case inhibitor alone
in terms of reducing cardiovascular mortality
especially in patients with reduced ejection fraction
now the question is are there studies on card
jacruverse remodeling in heart failure
with preserve ejection fraction
so with regards to cardiac rivers modeling
results okay so uh however
if you are quite uh because uh
we would want to see at the cut of value of your uh
left ventricular injection for that portion of
I say if you look at your data from all the trials
and so all the English and bacteria
left ventricular ejection fraction
so they're cut of Australia less than 40%
so
uh but some clinicians know uh
if they're much satisfied
the patient has really heart failure symptoms
at the onset now
uh regardless or without the benefit of the
through the airport results
so they would still start these patients on interest
along the way
okay for the next question
do we discontinue interest though
if there is improvement already
of the ejection fraction
okay so that's an excellent question now
because it is commonly asked
now in the cascading of this lecturer
so uh we all know that
this patients reduce ejection fraction benefited much
now with interest though and so
there has not been any study yet
that discontinuing your interest
or after achieving a good effect
or achieving your target ejection fraction
needs to be discontinued okay
so in fact the more that you should continue it
because the patient responded well with the medication
okay so I think we will be entertaining
last question for tonight
so
any comment on the use of irony in patients with CKD
or haemodialysis with have prep
okay so it's a good question so for patients on C K d
so of course with any
just like with any other medications
it should be used with caution okay
but with regards to uh I need a so again
so your irony is your Argentine syndrome
this is your interest
so for my to moderate uh chronic kidney injury
so you can still use your
entruster up to the highest dose
which is 200 mg twice the dosing okay
so for patients with severe C K
d for me to say less than E
G F R of less than 30 okay
so you can still use your irony interest
so but the lower dose
so which is your 50 mg twice daily dosing
okay for I think you still have one question
how much does impress the cost
I'm not quite familiar with the cost that uh
it's quite uh costly but but uh
since it is an innovator draft
you would expect that okay
but it's in the manner of uh
explaining it to your patients okay
since this medication has shown uh
significant positive results okay
so I think uh
patient would not uh
be very much concerned with the cost however
they have come up with programs to help your energy
and patients they
so they have their heart program
and then of course for government patients
they have a different brand of the same molecule
but at a lower price so that your
so that our indigent patients at
our regional hospitals can still benefit
can still benefit from this medication
I am I think
Doctor Illustrious Commentana says
between 1:30 to pay for tablet
okay lang
pagkatapos ng napakakomprehensibong panayam sa Covid 19 virus
hindi kaya
Dumating tayo ngayon sa isang napaka potensyal na epekto
o komplikasyon ng Covid virus
which is pagpalya ng puso
ngunit siyempre nananatiling pareho
kaya ang pamagat ng modyul ngayong gabi ay Heart Failure
Pamamahala
Pag-abot sa Pagsisimula ng Ospital sa Pangangalaga sa Outpatient
kaya
hayaan mo muna akong bigyan ka ng mga kahulugan ng pagpalya ng puso
kaya ayon sa European Society of cardiology
ito ay
isang abnormalidad ng istraktura o paggana ng puso
humahantong sa pagkabigo ng puso na maghatid ng oxygen
At ang recommensurated
mga kinakailangan ng metabolising tissues
Sa kabila ng normal na pressure sa pakiramdam
sa kabilang banda American Heart Association o isang C C H
a bigyan ang kahulugan na ito ay isang kumplikado
Clinic syndrome na nagreresulta mula sa anumang istruktura
o kapansanan sa pagganap ng partikular na pakiramdam o
pagbuga ng dugo
So ano na sila ngayon ang dahilan ng heart failure
kaya ito ay isang kumplikadong clinical syndrome
which is isang interplay ng iba 't ibang langis uh
mga bahagi ng puso
kaya alin ang mga dakilang sisidlan at ocardium
Myocardium at pericardium siyempre
kaya para sa ilan sa aking mga lektura
kaya maaaring narinig namin ang kalahating ref
kalahating bingi C H F o E H F kaya ano ang ibig sabihin nito
Kaya ang iyong kalahating hininga ay
ay kumakatawan sa iyong pinababang bahagi ng pagbuga
Heart failure kung saan ang iyong kaliwa
Ang partikular na bahagi ng pagbuga ay mas mababa sa
o malapit sa 35 hanggang 40% kalahating paliguan
sa kabila
Ang kamay ay isang heart failure na may reserve ejection fraction
ang daming gustong sabihin
mayroon silang ejection function na higit sa 40% higit pa
kaya ito ay tinatawag ding iyong diastolic dysfunction
tingnan mo
Ang bawat isa samakatuwid ay tumayo para sa iyong talamak na pagpalya ng puso
na isang patuloy at progresibong pagpalya ng puso
pagsunod sa isang nakakarelaks at nakakapagpagaling na kurso
at ang iyong talamak na pagpalya ng puso
ibig sabihin may mabilis
sa set
para sa pagbabago sa mga palatandaan at sintomas ng pagpalya ng puso
isang sitwasyong nagbabanta sa buhay
para saan
na nangangailangan ng agarang therapy o pagpapaospital
So ano ang ibig sabihin ng ejection fraction
dahil iyon ang lagi nating gustong marinig
mula sa aming duty equity point
So ejection fraction ay uh
uh ang dami ng dugong ibinubomba palabas ng ventricle
at higit doon
ng kabuuang dami ng dugo sa ventricle
mula doon makukuha mo ang iyong ejection fraction
So nandoon kami
Delineate ang iyong kasalukuyang ejection fraction
o bawasan ang bahagi ng pagbuga
patungkol sa mga sanhi ng pagpalya ng puso
syempre ang pinakakaraniwan o ang pinakakaraniwan uh
sanhi ng iyong pagpalya ng puso
nakawin ang iyong coronary heart disease
pagkatapos ang natitira ay sinusuri sa valvular heart disease
Cardiomayopathies at siyempre iba tubig
mga sakit sa balbula
at ilang nauugnay na hypertension at diabetes
para sa iyong kalahating kapanganakan
na karaniwang kilala bilang iyong diastolic dysfunction
So ito ang lagi naming ipinapaliwanag sa aming mga pasyente
baka alin
isang problema o kapaligiran
sa ventricular relaxation ng myocardium
na isang aktibong proseso na nadagdagan
paninigas ng ventricular
madalas na nakakaharap sa mga matatandang indibidwal
Ang mga value leg disease ay maaari ding maging sanhi ng kanyang kapanganakan sa kalusugan
pati na rin ang kanyang constructive pericarditis
pinakakaraniwang dala
Tuberkulosis
at ang ilan sa mga ito para sa talamak na pagkabigo ng aking vagal
kaya ang mahalaga ay malaman
ang epekto ng pagpalya ng puso sa mga pasyente
So siguro itong apat
napakahalagang aspeto ng epekto ng pagpalya ng puso
No. 1 maaari itong magdulot ng mga problemang pisikal at mental
uh as my hindi ko alam ng iba
uh mga 1 / 3 ng mga pasyenteng ito ay palaging nararamdaman uh
mababang mood o uh depression
sa pangatlo
ang ilan ay nagrereklamo sa pagpapababa ng iyong kalidad ng buhay
dahil sa lumalaban
igsi ng paghinga at madaling pagkapagod
So heart failure
ay madalas na isang progresibong sindrom na may kumplikado
mga kalakal na nagreresulta sa paulit-ulit na pagpapaospital
kaya ang antas ng paggamot
uh na ipinapatupad namin sa mga pasyente
halos nakadepende ito sa
porsyento ng tatlong naospital ng pasyenteng ito
at syempre
hindi namin nais na ang aming pasyente ay magkaroon ng biglaang puso
kamatayan na siyang pinakakaraniwang dahilan
ng kamatayan sa mga taong may banayad hanggang katamtamang pagpalya ng puso
kaya patungkol sa mga klinikal na kinalabasan
narito ang ilang mga katotohanan at kaya halos 10%
umunlad sa dami ng namamatay sa ospital
sa unang 90 araw
o tatlong buwan ng pasyente
50% halata
Ang mga pasyente ay maospital sa loob ng 90 araw
ngunit isang taon ay may 30% na pagkakataon
na baka ma-ospital muli ang pasyente
Sa susunod na limang taon ay may mas malaki
porsyento ng dami ng namamatay para sa mga pasyenteng ito
iyon ang klinikal na epekto ng pagpalya ng puso
Now based sa mga rehistrong ito
So sinabi na
So general practitioner registry ito okay
So five years survival rate
Para sa mga pasyente ng heart failure ay nasa 58%
gayunpaman isa pang pagpapatala ang magpapakita sa amin na
patungkol sa edad at kasarian
marami sa pangkalahatang populasyon mayroong 93% uh survivor rate
kaya
makikita natin sa mga figure na ito na may iba 't ibang uh
may contrasting uh degree ng uh registries
kaya
bakit ngayon ay wala pang 30 araw
ng mga pasyenteng may heart failure
unang na-diagnose
Napakahalaga nito dahil dito
So heart failure ay
isa sa mga pinakakaraniwang sanhi ng pagpapaospital
para sa mga pasyente na may edad na higit sa 65 taon
Kaya halos kalahati ng mga pasyenteng ito ay muling ginagawa
pinapasok pagkatapos ng paglabas
Since nung first year ng course nila
ngayon sa US lang
ang 30 araw-araw na rate ng pagpasok ay halos 25%
at sa Europa paumanhin ang mga rate ng pagpasok ay 25
34% sa 12 linggo
kaya baka gusto nating mahuli ang pasyenteng ito
ang mahinang mukha pagkatapos ng ospital
So ito ay sa vulnerable face na ito
na gusto naming i-optimize ang aming pamamahala
para sa mga pasyente ng heart failure
okay lang
lagi nating alam na karamihan sa mga ito ay mangyayari sa kalaunan
dumaan sa iyong talamak na pagpalya ng puso
So ayoko ng ganito
dahil ang dami ng namamatay sa loob ng 30 araw ay 10%
kaya ito ay isang napakahalagang slide
dahil karamihan sa mga pasyente ay pinalabas na ngayon
sa totoo lang
Nabigyan na ako ng uh uh baseline na gamot
Nuduce uh
kanilang pagpasok
na kinabibilangan ng iyong ace inhibitor o ARB beta blocker
Aldustaran antagonist siyempre
iyong nitrates
at ang ilan sa kanila ay bibigyan ng antiquotulants
So moving on na
So ito ang uh paradigm heart failure study
kaya ngayon ang paradigm heart failure studies
ay napakalaking pag-aaral
We 're in it para makita ang epekto uh
kung sakubiktima
Maaaring palitan ng balsatan at Casto ang isang asinhibitor
partikular ang iyong inal Aprill
So bakit inal aprill kasi
Inal Aprill pa rin ang malawakang ginagamit bilang inhibitor
at ang pinaka-pinag-aralan ay inhibitor pagdating sa
Heart failure management okay
So uh pareho silang pinagkumpara
So ano ang naging resulta
ang mga resulta ay nagpakita ng mga resulta ng solar study para sa pangunahin
Composite na mga kinalabasan
So cardiovascular kamatayan o ospital
ang pagkamatay ng lungsod o unang kaganapan
o ang pag-ospital sa pagpalya ng puso bilang unang kaganapan
pati na rin ang tatay mo mula sa CV
Pag-ospital sa proseso o pagpalya ng puso
kaya ipinakita nito na ang societal Vassar ay maaaring interesado
bagaman ipinakita
isang 20% kamag-anak na pagbabawas ng panganib
sa pag-ospital sa pagkabigo sa puso
pati na rin ang CBD bilang unang kaganapan laban sa iyong
sa ibang panalangin
kaya saka
nagkaroon ng 21% relatibong produksyon ng panganib
sa unang pag-ospital sa pagpalya ng puso
kaya tandaan na sa unang 30 araw
ito ang gusto nating iwasan okay
So first heart hospitalization noong January
ang talamak na yugto kaya
hindi namin nais na pumasok ang aming mga pasyente
kamatayan ng cardiovascular
kaya ang paradigm
Markahan ang pag-aaral ng pagkabigo
Ipinakita na mayroong 20% na kamag-anak na pagbawas sa panganib
patungkol sa iyong cardiovascular death
kaya sa loob ng 30 araw na paggamit
din ng bawat isa sa occipital valcytan
kaya nagkaroon ng
38% relative risk production sa 30 araw na ospital uh
Mga admission sa heart failure
at kaya kung saan ay lubos na makabuluhan
So bukod sa Biodynam heart failure study
kaya tungkol sa iyong occupital valscite at interes
bagaman kaya ang pioneer
ito uh doon
Tumayo ito sa isang pioneer heart failure trial
at transition studies kaya
parehong pioneer
at ang mga pag-aaral sa paglipat ay umaakma sa isa 't isa
okay kaya ito ay patungkol sa paggamit ng iyong uh
circulated vasor tapos na ang pagsisimula
uh para sa mga pasyente sa ospital ay libreng discharge
So it aim na malaman uh ang mga sumusunod
kaya ito ay nagpapatatag sumusunod at talamak
ang bayad na pagpalya ng puso
Present na o halos na-diagnose na pagpalya ng puso
at sa anumang ace inhibitor o ARB na dosis bago ang pagpasok
o isang ace inhibitor Arbina ay
okay so ito ang pinag-uusapan ko
Kaya ang dalawang pag-aaral na ito ay umaakma sa isa 't isa
okay kaya para sa Baunia heart failure
So uh ikinumpara sa ace inhibitorinaloprel mo
okay bilang isang libreng pagsisimula ng paglabas
So habang may transition study
kaya layunin nitong sukatin ang proporsyon ng mga pasyente
pagkamit ng target na dosis na 200 mg
at Tristol PID 10 linggo pagkatapos ng randomization
So sa transition studies
ang pangunahin
Ang layunin ay suriin ang proporsyon ng mga pasyente
kasama ang
Target na dosis ng interes sa 200 mg AIP sa linggo 10
Mag-post ng randomization sa pre at post discharge
kaya tandaan at din
bakit ito napakahalaga
sa pre at post discharge
dahil nasa stage na tayo
Gusto naming i-optimize ang aming pamamahala sa pagpalya ng puso
So may India
Naiintindihan mo na inilalantad namin ang randomization
kaya ang pangunahing pamantayan sa pagsasama tulad ng sumusunod din
Ang mahalagang malaman ay ang LV
Fraction ng pagbuga
Dapat ay mas mababa sa 40% sa screening
So yung Niha classification
Hinati sa pagitan ng klase 2 hanggang klase 4
kaya ito ay pantay na ipinamahagi sa buong mundo
Kaya sa katunayan mayroon silang 150 mga site para sa mga pag-aaral na ito
kaya 90 bansa ang lumahok sa pag-aaral
Kaya ang disenyo ng pag-aaral ay ang mga sumusunod
kaya nagkaroon ng randomization para tutulan ang discharge a
So uh nahati sa tatlong strata
at kaya mayroon kang iyong A 'S plus 0 m t
0 o m t ay pinakamainam na medikal na therapy
isang R B + o m t at o m t
ngunit isang C inhibitor o isang r d na a ng mga pasyente okay
Kaya nagsimula ang Intrasto sa mababang dosis
at na-rate ang pag-update sa maximum na dosis na 200 mg b I d
kaya
ang mga katangian ng baseline para sa mga pasyente sa pre
Ang discharge at post discharge ay halos magkapareho
pero syempre
Mahalagang tandaan na sa pag-aaral ng paglipat
karamihan sa iyong mga pasyente ay mas matanda
at magkaroon ng mas malubhang sintomas ng heart failure okay
Kaya dapat lagi mong tandaan ang isang ito
Kaya bakit ito mahalaga
So ito ay nangangahulugan na karamihan sa mga pasyente sa katunayan
maaaring nasa talamak
binayaran nila ang heart failure stable
kaya nga uh nagkaroon sila ng ganitong sintomas ng heart failure
So moving on na kaya
karamihan sa mga pasyenteng ito ay mayroon ding medyo
More comorbidities kumpara sa nakaraang pag-aaral
kaya ano ang ipinakita nito kaya ang pangunahing punto ng pagtatapos
kaya ang target na dosis ng interesado 200 mg
The I d dosing was a chill okay
pati na rin ang pangalawang punto ng pagtatapos
ngayon kami ay nasa interes ng Aah
na-maximize hanggang 200 mg
b a d umabot ng hanggang 10 linggo
at pagkatapos ay tungkol sa mga salungat na kaganapan
So halos pareho lang
ngayon para sa nakaraang simbahan at postistang simbahan uh
istraktura ngunit wala sa kanila ang umabot sa 5% na cut off
So medyo compatible ang mga adverse events
sa magkabilang grupo
ginawa sa nakaraang simbahan at i-post ang simbahang ito
So ano kaya yun
Mga predictor para sa matagumpay na interes o apetration
kaya baka gusto mong tingnan ang isang ito
So karamihan sa mga pasyenteng ito uh
medyo uh nabibilang sa 65 taong gulang
syempre dapat magpakita sila ng magandang gfr sa linyang ito
matatag na chemodynamics
pati na rin ang mga pasyente na may kasaysayan ng hypertension
So uh patungkol sa kinalabasan nila
kaya hindi ito nag-iba o hindi nagbago
ako sa isang pre discharge o post discharge sa
kaya
ang mga pagkumpleto ng pag-aaral ng paglipat ay bilang mga file
uh nagpakita ng maihahambing na proporsyon ng mga pasyente
nakilala ang pangunahin at pangalawa at barya
sa mga pagsisimula bago at pagkatapos ng paglabas
So halos kalahati ng mga pasyente na may kalahating ref
o bawasan ang bahagi ng pagbuga
nagpapatatag pagkatapos ng talamak
Compensated na kaganapan sa pagpalya ng puso
makamit ang target na dosis na 200 milligrams
uh b ako d
sa loob ng 10 linggo
kaya higit sa 86% ng mga pasyente sa parehong grupo
pagtanggap ng anumang dosis sa loob ng dalawang linggo o mas matagal pa
nang walang pagkaantala
ngayon ang mga salungat na kaganapan na naghahambing sa iyong interes bagaman
hindi kami ay pre at post discharged sa halagang iyon sa lahat
So pagsisimula ng interes
bagaman sa isang malawak na hanay ng mga pasyente na may kalahating hininga
ilang sandali matapos ang isang talamak
binayaran nila ang pagpalya ng puso sa
sa ospital o sa ilang sandali matapos ang paglabas ay nakita
at sa pangkalahatan ay mahusay na disimulado
So moving on sa pioneer study
kaya ang pag-aaral at mga punto ng pag-aaral na ito ay ang oras
karaniwan
proporsyonal na pagbabago sa antiprophy at konsentrasyon
mula baseline hanggang linggo 4 hanggang 8
tinutukan din nito si Aah
tingnan ang profile ng kaligtasan ng Aah circuit
na may tiyak na interes
So ito ay isang walong linggong pag-aaral
muli ang paghahambing ng iyong pabilog
vulciartan na interes kumpara sa iyong 10 milligram
In alope Vera dalawang beses araw-araw na marker
at pagkatapos ay suriin ang nasuri na biomarker
uri ng pagiging epektibo nito
pati na rin ang kaligtasan at pagpaparaya
at mga klinikal na kinalabasan kaya
Narito ang mga pangunahing klinikal na pamantayan
para sa pag-aaral ng pioneer
napakahalagang tandaan muli na uh mga pasyente
nakatala sa pag-aaral ay pinatatag muna sa moderna
okay ang mental
Kaya kailangan nating sabihin uh
ang sistematikong presyon ng dugo
Dapat ay higit sa 100 millimeter mercury
nang walang paggamit ng anumang mga bakal na tubo sa lahat
pati na rin ang iyong mga vasodilator
So study dose hydration kaya uh
ang mga interes bagaman ay pinalaki
uh depende sa kanilang uh hemodynamic status
kaya ang target na dosis ay maabot ang 200 milligram na dosis
ang ID ng iyong interes bagaman o ang iyong panloob na antas
dalawang beses araw-araw dosy kaya muli
ang mga katangian ng baseline para sa magkabilang braso
So were pretty similar kaya mahalagang malaman
na isang pangunahing punto ng pagtatapos
ay para sa mga pasyente sa mga interes
o medyo
ipakita ang malaking pagbawas ng degree sa iyong NB Pro
BNP mula sa iyong mga araw gabi
So for the information ng lahat
kaya ang iyong NP Pro BNP ay isang uri ng get marker
uh para sa iyong uh kalubhaan ng iyong pagpalya ng puso
sa akin upang makita ang mas mataas na ito ngayon
So akala mo uh
ang antas ng pagpalya ng puso ng mga pasyente ay nasa
ang mas mataas na bahagi
kaya patungkol sa malubhang clinical composite endpoint
okay kaya uh nagkaroon ng mas kaunting antas ng iyong kamatayan
ospital sa ospital
pati na rin ang paggamit ng iyong
Iniwan ang partikular na assist device
at pagkatapos ay ang posibleng pangangailangan para sa paglipat ng mata
So keys of group analysis ay nagpapakita na uh
karamihan sa mga pasyente ngayon
uh sa mapanghimasok na braso ipakita uh mas mahusay na mapagkukunan
Alam ng mga resulta tungkol sa kanilang pagpalya ng puso
at pagkatapos ay sa posibleng paggamit ng iyong acvator o ERD
ngayon para sa profile ng kaligtasan na napakahalaga uh
kaya
patungkol sa paglala ng paggana ng bato
sa heartbreak
ano ang mahalagang mapansin ang posibleng epekto uh
side effect ng angiodema
kaya na isang malubhang uri ng hypersensitivity
kaya
ito ay naitala lamang sa isang pasyente
at interes bagaman din at sa tingin ko apat sa
ito ang mga konklusyon ng pioneer heart failure bilang
gaya ng sumusunod
ito ay muling kinukumpirma ang higit na kahusayan ng interes ng
higit sa 80 hivatory na ipinakita sa paradigm heart failure
ngayon ay ipinakita sa setting ng ospital
sa isang malawak na hanay ng mga pasyente na may FFR
okay lang
nasa ospital
Ang pagsisimula ng interes ay inihambing sa inalaprete
humahantong sa
makabuluhang antas at mas mabilis na pagbabawas ng iyong
Antipro B & P
So nagkaroon ng matinding pagbawas sa seryoso mo uh
Okay ang mga klinikal na kinalabasan
kaya
The pioneer heart failure reconfirms na sa ospital
pagsisimula ng interes
Kahit na sa ilang sandali pagkatapos ng hemodynamic stabilization
may kaligtasan at maihahambing sa inal appeal
kaya muli
kinumpirma muli ng iyong pioneer ang higit na kahusayan ng interes
Though over easy need o nasa setting ng ospital
So what uh since title namin uh
maabot ang iyong nasa ospital sa pangangalaga sa outpatient
So anong magagawa natin as clinicians okay
So kami sa B I d H
ay nagawang makabuo ng paglilinis ng pagpalya ng puso
And so na inilunsad last year kaya ah
nagawa namin
sa ngayon upang tulay ang takip na ito sa panloob na ospital
at pangangalaga sa ovation
So in fact sa pag-aaral ni Doctor Katarina Modovar
isa sa mga matatandang residente
So sinadya niyang tumingin
At ang klinikal na profile ng mga pasyente sa
ang Heart Failure Clinic
Ospital ng Pagsasanay at Pagtuturo sa Libangan
So ito ang uh initial study bilang okay
kaya narito ang ilang mga larawan ng
ang paglulunsad ng Heart Failure Clinic
At ang rtph noong nakaraang taon
kaya ang mga unang resulta ng pag-aaral ng coronavirus
ipakita mo yan uh
uh mayroong 81 kabuuang console
nakita nila
Naabutan na namin ang kabuuang mga console
gayunpaman pandemya uh super strike
So we were itinigil namin yung recruitments namin
o mga konsultasyon sa Heart Failure
Clinic mula noong Marso ngayon
So nung nagsimula yung ECQ nakita nila ah
okay kaya patungkol sa bawat pamamahagi
kaya uh karamihan sa kanila ay kabilang sa 41 hanggang 60 pulgadang batas
So heart failure uh
sa gayon
ang pamamahagi ng pagpalya ng puso
ay higit pa sa ilalim ng pinababang ejection fraction okay
kaya halos 81% sa kanila ay nagkaroon
nabigo
at 50 lamang sa kanila ang nakareserba ng bahagi ng Egypt
patungkol sa etiology okay
So still so nagkahiwalay kami
Um kasama uh
Mga sensor na karaniwang sanhi ng iyong
Okay naman ang coronary artery disease
sinundan ng iba
kaya ito ay posibleng dilat na cardiomyopathy
at pagkatapos ay sinundan ng iyong cellular heart disease
uh sorry at pagkatapos ay ang iyong cardiomyopathies
So ang distribution ng mga pasyente and so are actually
Kaya dahil kami ay catering sa Antarctical rehiyon
kaya ngunit karamihan sa aming mga pasyente ay nasa
lalawigan ng Albi
So most of them nasa high organized areas tayo
kaya sa ikalawang distrito ng Albay
So patungkol sa mga sintomas ng heart failure
Sa pag-aaral na ito ipinakita na uh
Kinukumpleto pa rin ng mga pasyente ang pagkapagod na ito
Sakit sa dibdib at hirap sa paghinga
So sobrang excited kami sa
resulta ng pag-aaral na ito
Kaya hinihintay namin ang mga huling resulta ng pag-aaral na ito
kaya sa konklusyon
kaya ang pioneer heart failure ay complement
interesado ba sila sa pag-aaral
kaya uh kailangan natin sa isang transitional paradigm
pag-aaral ng heart failure
kaya sa pamamagitan ng unyon
Ipinapakita ng mga pag-aaral sa paglipat na maaaring simulan ang mga interes
bago ang paglabas o sa lalong madaling panahon pagkatapos ng pagpapapanatag
upang makatulong na panatilihin ang iyong mga pasyente na may kalahating ref sa bahay
at syempre
better be protected dahil sa panahong ito ng pandemic
ang covid pandemic
hindi namin nais na makita ang aming mga pasyente nang regular
At ang aming mga klinika upang mabawasan ang kanilang pagkakalantad
So hangga 't gusto natin
para matrato natin sila uh ang ginhawa ng kanilang tahanan
So I think last line na kaya pasensya na
kaya narito ang ilang uh mahalagang ibahagi
kasi
sa European Society of cardiology consensus okay
So initiation ng occupital sa pamamagitan ng site
at sa halip na ace inhibitor o isang ARP
maaaring isaalang-alang para sa mga pasyenteng naospital
na walang pagkabigo sa uri ng sagot
o nagbayad sila
Heart failure gaya ng ipinapakita sa iyong paradigm
Heart failure anak
So ganun din sa
pinagkasunduan ng eksperto ng Heart Failure Association
ng America at pagkatapos ay ang European Society of cardiology
So with that salamat at magandang gabi
okay salamat sa Doctor Shockson
para sa napaka-kaalaman na panayam
Kaya ngayon ay magpapatuloy tayo sa bukas na forum
Kaya sa kasalukuyan mayroon kaming dalawang katanungan dito
ang mga unang tanong ang unang tanong ay
para sa ilang bayad na pagpalya ng puso
regular ba kaming humihiling ng MT Pro BMC
lalo na sa mga pasyente
klinikal na nagpapakita ng mga sintomas ng pagpalya ng puso
okay lang
kung gusto mong tapusin ang iyong trabaho
para sa iyong pagpalya ng puso kaya perpektong isang MD
Dapat hilingin kay Brody at B okay
dahil ito ay isang surrogate marker para sa iyong
Diagnosis ng pagkabigo sa puso
pero syempre sa mga nakaraang taon
kaya NP Pro
Hiniling ang BNP
pangunahin upang makilala kung ang iyong mga sintomas ay
uh patungkol sa cardiac in origin o respiratory in
pinanggalingan okay
kaya kailangan nating sabihin
kung magbubunga ka ng mas mataas na resulta ng iyong MP program
may sintomas ng uh
madaling mataba at kakapusan sa paghinga okay
kaya marahil ikaw ay nakikitungo sa cardiac sa pinagmulan
So gaano kadalas
okay kaya syempre pwede mo gawin minsan lang okay
kaya
upang makita kung mayroon kang mas mataas na mga resulta ng iyong antiprogane
kaya pala
bawat ospital ay may cut off para sa antipropy NB
So nakita nasha uh habang may practice
kaya may cut off para sa talamak na pagpalya ng puso
at pagkatapos ay talamak na pagpalya ng puso
at pagkatapos ay ang pangatlo ay magiging uh
belongshare kaysa sa hiwa ng mga antas
na higit na nakikitungo sa pinagmulan ng paghinga
kaya ang susunod ay komento mula kay Doctor Salasar
napaka informative na talakayan
Ang mga hukbo ng doktor ay nagpakita na mas mataas kaysa sa iba pang mga gamot
tulad ng case inhibitor lamang
sa mga tuntunin ng pagbabawas ng cardiovascular mortality
lalo na sa mga pasyente na may pinababang bahagi ng pagbuga
ngayon ang tanong ay may mga pag-aaral ba sa card
Jacruverse remodeling sa pagpalya ng puso
na may preserve ejection fraction
kaya patungkol sa pagmomodelo ng mga ilog ng puso
okay ang mga resulta kaya uh gayunpaman
kung ikaw ay medyo uh dahil uh
Gusto naming makita sa pagbawas ng halaga ng iyong uh
left ventricular injection para sa bahaging iyon ng
Sinasabi ko kung titingnan mo ang iyong data mula sa lahat ng mga pagsubok
at kaya lahat ng Ingles at bakterya
kaliwang ventricular ejection fraction
kaya sila ay pinutol ng Australia na wala pang 40%
kaya
uh pero alam ng ilang clinician uh
kung sila ay lubos na nasisiyahan
may sintomas talaga ng heart failure ang pasyente
At ang simula ngayon
uh anuman o walang pakinabang ng
sa pamamagitan ng mga resulta ng paliparan
kaya sisimulan pa rin nila ang mga pasyenteng ito sa interes
sa daan
okay para sa susunod na tanong
ihihinto ba natin ang interes
kung may improvement na
ng ejection fraction
okay kaya iyan ay isang mahusay na tanong ngayon
dahil ito ay karaniwang tinatanong
ngayon sa cascading ng lecturer na ito
So uh alam naman nating lahat yun
ito pasyente bawasan ejection fraction nakinabang magkano
ngayon na may interes bagaman at kaya
wala pang pag-aaral
na huminto sa iyong interes
o pagkatapos makamit ang isang magandang epekto
o pagkamit ng iyong target na ejection fraction
Kailangang ihinto okay
So in fact the more na dapat mong ipagpatuloy ito
dahil ang pasyente ay tumugon nang maayos sa gamot
okay so I think magiging entertaining tayo
huling tanong ngayong gabi
kaya
Any comment sa paggamit ng irony sa mga pasyenteng may CKD
o hemodialysis na may paghahanda
okay kaya magandang tanong kaya para sa mga pasyente sa CK d
So syempre sa kahit ano
tulad ng iba pang mga gamot
dapat itong gamitin nang may pag-iingat okay
pero patungkol sa uh kailangan ko ulit
So ang irony mo ay ang Argentine syndrome mo
ito ang iyong interes
kaya para sa aking katamtaman uh talamak pinsala sa bato
para magamit mo pa rin ang iyong
ipagkatiwala hanggang sa pinakamataas na dosis
Which is 200 mg dalawang beses ang dosing okay
kaya para sa mga pasyente na may malubhang C K
d para mas mababa ang sasabihin ko kaysa sa E
G F R na wala pang 30 okay
para magamit mo pa rin ang iyong irony interest
kaya ngunit ang mas mababang dosis
kaya alin ang iyong 50 mg dalawang beses araw-araw na dosing
okay para sa tingin ko may tanong ka pa
magkano ang tumatak sa gastos
Hindi ako masyadong pamilyar sa gastos na uh
medyo mahal pero uh
dahil isa itong innovator draft
aasahan mo na okay
ngunit ito ay sa paraan ng uh
Ipaliwanag mo sa mga pasyente mo okay
dahil ang gamot na ito ay nagpakita uh
makabuluhang positibong resulta okay
kaya sa tingin ko uh
hindi gagawin ng pasyente uh
maging lubhang nababahala sa gastos gayunpaman
nakabuo sila ng mga programa upang matulungan ang iyong enerhiya
at mga pasyente sila
So may heart program sila
at saka syempre para sa mga pasyente ng gobyerno
mayroon silang ibang tatak ng parehong molekula
ngunit sa isang mas mababang presyo upang ang iyong
upang ang aming mga mahihirap na pasyente sa
Makikinabang pa rin ang ating mga rehiyonal na ospital
Maaari pa ring makinabang mula sa gamot na ito
Ako ay iniisip ko
Sabi ni Doctor Illustrious Commentana
sa pagitan ng 1: 30 upang magbayad para sa tablet
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