2. DIAGNOSIS
No symptoms = no heart failure

3. 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

4. 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

5. 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

6. 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 (

7. Management of chronic heart failure : pharmacology

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

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

10. Management of chronic heart failure : devices and interventions

11. 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 !!!

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

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

14. 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)

15. Importance of comorbidities :

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

17. 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

18. Time is muscle

20. 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