'Time to therapy ' concept in AHF Syndromes

41 Pages·2013·2.82 MB·English

M. Birhan Yılmaz M.D, FESC
Professor of Medicine
Department of Cardiology
Cumhuriyet University
Sivas, TURKEY
 Time to therapy concept in CV disease
 Time concept in AHF: Overlooked data so far
 Recent data and paradigm shift
Disclosures: PI in Novartis and Cardiorentis studies
Treat Early or Die
VENTRICULAR TACHYCARDIA
ACUTE MYOCARDIAL INFARCTION
CEREBROVASCULAR ACCIDENT
PNEUMONIA
HYPOGLYCEMIA
HYPOXIA
 Where AHF stands with regard to time?
 Any evidence???:
Data derived from prospective randomized study versus
registry
What am I supposed to measure?: «Dyspnea» and/or
«outcome»
 Question: Is there an opportunity window for
AHF just like other diseases?
 Answer: Probably yes…

Mebazaa et al Intensive Care Medicine 2011
ALARM-HF: IV treatment at admission
inotropes
Mebazaa et al Intensive Care Medicine 2011
6
.
0
Epinephrine
y
t
i 5
l
a .
0
t
r Norepinephrine
o
m
4
.
0
l
a
t
i
p 3 Dopamine
s .0
o
Dobutamine
h
-
2
n
.
I 0 Whole cohort
1
Diuretics
.
0
Levosimendan
0
. Nitrates
0
0 5 10 15 20 25 30
Days
Mebazaa et al Intensive Care Medicine 2011
logit(Propensity)
SBP
SBP
Hypertension
hypertension
Diabetes
Dyslipidemia
Orthopnea
Rales
Cardiogenic shock Use of
Weight gain
Oxygen sat.*
NYHA/II
vasodilators in
Age/15-45
Periph. oed.
Obesity
Cadiomyopathy ALARM-HF
Weight
Heart Rate
Age/80>
Heart valve dis.
LVEF*
Dyspnoea
Fatigue
Age/61-70
De novo AHF
Female
Cool extremities
NYHA/IV
CHF
Pre-match
Secondary AHF
Age/46-60 Post-match
Sodium*
Coronary artery dis.
Uric acid*
Jug. ven. dist.
Creatinine*
Afib/Acute Before propensity After propensity score
NYHA/I
NYHA/III score match match
BB pre-hosp
Age/71-80
ACE history
Afib/Not spec. IV vasodilatators No IV vasodilatators No
Afib/Chron
Periph. valv. dis.
NYHA/No N=1805 N=2362 N=1007 N=1007
Afib/Acute & Chronic
0 20 40 60 80 100
Absolute standardized difference (%)