Outpatient Heart Failure Management UCVA 4th Annual Cardiovascular Conference 09/29/2012 Eugene Storozynsky, M.D., Ph.D., F.A.C.C Assistant Professor of Medicine Program in Heart Failure and Transplantation Director, Cardio-Oncology Program Cardiology Division University of Rochester
No Disclosures
EVOLUTION OF CLINICAL STAGES
NORMAL Asymptomatic LV Dysfunction No symptoms Compensated Normal exercise CHF Abnormal LV fxn No symptoms Decompensated Exercise CHF Abnormal LV fxn Symptoms Refractory Exercise CHF Abnormal LV fxn
No symptoms Normal exercise Normal LV fxn
Symptoms not controlled with treatment
ACC/AHA Classification of Heart Failure (HF) Stage
Patient Description
High risk for developing HF
Hypertension (HTN), diabetes, CAD, FHx of cardiomyopathy
B
Asymptomatic HF
Previous MI LV systolic dysfunction Asymptomatic valvular disease
C
Symptomatic HF
A
D
Refractory end-stage HF
Known structural heart disease Shortness of breath and fatigue Reduced exercise tolerance Symptoms at rest despite maximal medical therapy; candidates for device Rx or transplantation
Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113.
Epidemiology of Heart Failure in the United States
10.0 Patients in US (millions)
10 8
4.79 million patients1; estimated 10 million in 20372
6
Incidence: about 550,000 new cases each year1
4
4.8
Prevalence is 2% in persons aged 40 to 59 years, progressively increasing to 10% for those aged 70 years and older3
3.5
Sudden cardiac death is 6 to 9 times higher in the heart failure population1
2 0
1991
2001
2037
Year 1. American Heart Association. 2002 Heart and Stroke Statistical Update. 2001. 2. Croft JB et al. J Am Geriatr Soc. 1997;45:270–275. 3. National Heart, Lung, and Blood Institute. Congestive Heart Failure Data Fact Sheet. Available at: http://www.nhlbi.nih.gov/health/public/heart/other/CHF.htm.
Neurohormonal Activation in Heart Failure: A Vicious Cycle
