M. JESSUP Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano aprile 2010

Genders and Heart Failure: Difference and Analogies Prognostication Assessment in Heart Failure Women: Do we have enough skill? Mariell Jessup MD, FAHA, FACC Professor of Medicine University of Pennsylvania

Women in low LVEF heart failure trials.

1063 persons 45% survival at 5 years Circ Heart Failure 2008; 1:91-97

“Long-term coffee consumption was not associated with an increased risk of stroke in women. In contrast, our data suggest that coffee consumption may modestly reduce risk of stroke. Nurses Health Study

Clinical –Age –Gender –Etiology –HR/BP –BMI –Respiratory Rate –HF Signs/Symptoms –Recent Hospitalization –LVEF –Atrial Fibrillation –VT/VF Comorbidities –Cancer/PVD/CVA –Diabetes Mellitus –Smoking/COPD/Sleep Apnea –Alcohol –Liver Disease –Depression –Dialysis Functional –NYHA Class Prior to Admit and 30 day Laboratory - Admit and D/C –Sodium –BUN/Cr –Total Bilirubin –AST/ALT/Albumin –Hgb/WBC/RDW/%Lymphs –Uric acid –Cholesterol –BNP –Troponin Medications/Device - Admit and D/C –Diuretics - Type and Daily Dose –ACEI –ARB –CCB –B blocker –Aldosterone Blockers –Hydralazine/Nitrate –Statin –ASA/NSAID/Clopidogrel –Digoxin –BiV ± ICDs –Inotrope Use Prognostic Predictors in HF

Goldberg, Jessup Circulation 2007; 116:360

ADHERE ® CART: Predictors of Mortality SYS BP 115 n=24,933 n=7, %n=5, %N=2, %n= %n=1, %n=4, %n=20,834 BUN 43 N=33,324 Greater thanLess than 2.68%n=25, %n=7,202 Cr ,045 Highest to Lowest Risk Cohort OR 12.9 (95% CI ) Fonarow GC, et al. Risk stratification for in-hospital mortality in heart failure using classification and regression tree (CART) methodology. JAMA. 2005;293: ,324 patients!

JACC 2010; 55: 872

JACC 2008; 52: , 612 patients

The Prognostic Value of Maximal Oxygen Consumption VO 2 > 14 ml/Kg/min VO 2 ≤ 14 ml/Kg/min (listed)* VO 2 ≤ 14 ml/Kg/min (not listed)* Circulation 1991;83: * p 14

O’Neill et al. Circulation 2005; 111:2313

2331 patients 28% women NYHA II-IV Low LVEF

BNP Concentration for the Prediction of Clinical Events Harrison A. Ann of Emerg Med 2002; 39: ) % 5% 10% 15% 20% 25% 30% 35% 40% 45% BNP < 230 pg/ml BNP pg/ml BNP > 480 pg/ml Death or Heart Failure Hospitalization Days N = 325

JACC 2008; 52: NT-proBNP: 1078 pg/ml

In this population of women, higher baseline blood levels of NT-proBNP were associated with the future development of SCD, and this relationship was independent of established risk factors for CHD and/or SCD.

Stempfle et al. J Heart Lung Transplant 2008;27:222

Mullens et al. Am J Cardiol 2008; 101:1297

Risk Stratification for Mortality with HF Seattle Heart Failure Score 1 Year ROC

Circ Heart Failure 2008; 1: Health Aging and Body Composition

Aaronson et al. Circulation 1997;95: Heart Failure Survival Score

Risk Stratification I would counsel my heart failure patients to consider advanced therapies (such as VAD or transplant) or discuss end-of-life issues if the predicted annualized mortality rate was: % % % % 5. > 50% 6. I would not counsel the patients for either approach