Heart Failure Mngt

Summary

The 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

00:00

😷 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.

05:02

🏥 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.

10:04

💊 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.

15:05

🔬 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.

20:08

🏥 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.

25:10

🌐 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.

30:10

💬 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.

Keywords

💡Heart Failure

Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It is a central theme in the video, discussing its management and complications. The script mentions heart failure in various contexts, such as reduced ejection fraction and preserved ejection fraction, highlighting its impact on patients and the importance of treatment.

💡Ejection Fraction

Ejection fraction is a measure of how much blood the heart pumps out with each beat. It is a critical concept in the video, used to classify heart failure as either reduced (less than 35-40%) or preserved (more than 40%). The script discusses the significance of ejection fraction in determining the severity of heart failure and the treatment approach.

💡Coronary Heart Disease

Coronary heart disease is a condition where the heart's blood supply is blocked, often due to plaque build-up in the coronary arteries. The script identifies it as a common cause of heart failure, emphasizing its role in the development of the condition and the need for management strategies to address it.

💡Valvular Heart Disease

Valvular heart disease involves problems with the heart's valves, affecting their ability to open and close properly. The script mentions it as another cause of heart failure, indicating that valve disorders can lead to the condition and may require specific treatments.

💡Cardiomyopathies

Cardiomyopathies are a group of diseases that affect the heart muscle, making it harder for the heart to pump blood. The script refers to cardiomyopathies as a cause of heart failure, showing their relevance in the overall discussion of the condition's etiology and management.

💡Acute Heart Failure

Acute heart failure is a sudden worsening of heart failure symptoms that requires urgent treatment. The script describes it as a life-threatening situation that necessitates immediate hospitalization, highlighting the urgency in managing this type of heart failure.

💡Chronic Heart Failure

Chronic heart failure is a long-term condition where the heart gradually loses its ability to pump blood effectively. The script contrasts it with acute heart failure, emphasizing the progressive nature of chronic heart failure and the need for ongoing management.

💡Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors are a class of drugs used to treat heart failure by reducing the strain on the heart. The script discusses ACE inhibitors as part of the standard treatment for heart failure, noting their benefits in managing the condition.

💡Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors

SGLT2 inhibitors are a newer class of drugs that have shown benefits in heart failure management. The script mentions SGLT2 inhibitors in the context of the PARADISE-HF study, discussing their potential to reduce heart failure hospitalizations and improve outcomes.

💡Diastolic Dysfunction

Diastolic dysfunction refers to the impaired ability of the heart to relax and fill with blood between beats. The script identifies it as a type of heart failure with preserved ejection fraction, explaining its role in the condition and its impact on patients.

💡Heart Failure Clinic

A heart failure clinic is a specialized healthcare setting dedicated to the management of heart failure patients. The script mentions the establishment of a Heart Failure Clinic, indicating its importance in providing comprehensive care and support for patients with heart failure.

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