DIAGNOSIS No symptoms = no heart failure

DIAGNOSIS NT pro BNP and BNP : cut off for exclusion Therefore, the use of NPs is recommended for ruling-out HF, but not to establish the diagnosis Roberts E, et al.. BMJ 2015; Zaphiriou A, et al. Eur J Heart Fail 2005; Fuat A, et al. Br J Gen Pract 2006;Yamamoto K, et al. J Card Fail 2000; Cowie MR, et al. Lancet 1997; Krishnaswamy P, et al. Am J Med 2001; Kelder JC, et al. J Card Fail 2011

NEW CLASSIFICATION Middle child of HF (ejection fraction 40-50%) : 10-20% HF population and poor prognosis. Diagnosis of HFpEF: structural (LAVI>34 mL/m2 or LVMI ≥115 g/m2 (m) ≥95 g/m2 (f) ) of functional (E/e′ ≥13 mean e’ < 9 cm/s) abnormalities

Management of chronic heart failure : pharmacology Reduce mortality for any reason for cardiovascular reasons Preventing HF hospitalization Improve clinical status functional capacity quality of life ARBs are recommended only as an alternative in patients intolerant of an ACEI

Management of chronic heart failure : pharmacology : Others LCZ696 is recommended to replace ACEIs in ambulatory patients who remain symptomatic despite optimal therapy and who fit the criteria of the pivotal trial. PARADIGM-HF Ivabradine has been shown to improve outcomes in patients with increased heart rate, and should be considered when appropriate (

Management of chronic heart failure : pharmacology

Management of chronic heart failure : pharmacology Treatments (or combinations of treatments) that may cause harm in patients with symptomatic (NYHA Class II– IV) HFrEF

Management of chronic heart failure : devices and interventions : 2012 vs 2016

Management of chronic heart failure : devices and interventions

Management of chronic heart failure : devices and interventions Independent predictors of Benefit of CRT • Younger patients • Women • QRS Duration • Not LVEF ! • Not Aetiology ! • Not QRS Morphology !!!

Revascularization • No change • STICHES might become future IIb/B recommendation?

Importance of comorbidities : Their management is a key component of the holistic care of patients with HF

Importance of comorbidities : 1/ Betablockers and ivabradine ( in selected patients) are effecitve agents for angina control 2/ CABG is recommended for patients with : signifiant left main stenosis of left main equivalent to improve prognosis HFrEF and signifiant CAD (LAD or multivessel)

Importance of comorbidities :

Importance of comorbidities : IV ferric carboxymaltose has been shown to improve HF symptoms, quality of life, exercice capacity in iron deficient patients with HFrEF

Acute heart failure : Acute Heart Failure refers to rapid onset or worsening of symptoms and/or signs of HF. It is a life-threatening medical condition requiring urgent evaluation and treatment, typically leading to urgent hospital admission

Time is muscle

Pre-discharge management and criteria for discharge : Patients admitted with AHF are medically fit for discharge: when haemodynamically stable, euvolemic, established on evidence-based oral medication and with stable renal function for at least 24 h before discharge once provided with tailored education and advice about self-care Develop a careful plan that provides: schedule for up-titrating and monitoring of pharmacological therapy need and timing for review for device therapy who will see the patient and when Patients should be: enrolled in a disease management program seen by their general practitioner within 1 week of discharge seen by the hospital cardiology team within 2 weeks of discharge (if feasible)  to prevent early hospital re-admission