Kevin S Shah, MD Profile picture
Jul 30, 2018 10 tweets 11 min read Twitter logo Read on Twitter
#FITSurvivalGuide: #HeartFailure management — a #tweetorial for #ACCFIT

1️⃣ Non-pharmacologic
2️⃣ Acute HF
3️⃣ Staging
4️⃣ HFrEF
5️⃣ HFpEF
6️⃣ Devices
7️⃣ Advanced Tx
8️⃣ Misc
Resources: @HFSA @ishlt @AHAScience @JACCJournals @HRSonline
1️⃣ Non-pharmacological therapies for HF:
➖Cardiac rehabilitation can improve functional capacity, exercise duration & mortality
➖Diet: Low Na (2-3 g/day) diet to reduce congestive symptoms
➖Biomarkers have an important role in diagnosis and prognosis of patients with HF
2️⃣ Acute Heart Failure Treatment agenda:
➖ Stabilize condition based on hemodynamics profile
➖ Establish dx, etiology and precipitating factor
➖ Initiate therapy for symptom relief
➖ Preload/afterload reduction
➖ Inhibition of neurohormonal activation for long term mgmt
3️⃣ Treatment for chronic HF is depending on ACC/AHA stage and NYHA functional Class
4️⃣ Treatment of HFrEF relies on medical therapies including ACE/ARB, beta-blocker, mineralocorticoid antagonists and vasodilators in select patients. Important novel medical therapies include angiotensin receptor blocker and neprilysin inhibitor (ARNI) & Ivabradine
5️⃣ Treatment of HFpEF includes:
➖ Control of heart rate & blood pressure
➖ Volume management via diuretics
➖ Potential benefit with aldosterone antagonism for re-hospitalization (TOPCAT)
➖ Wireless implantable hemodynamics monitoring (CardioMems) (CHAMPION)
6️⃣ Device therapy (primary prevention) includes ICD consideration:
➖LVEF<35% due to MI, NYHA 2/3
➖LVEF<30% due to MI, NYHA 1
➖LVEF<40% with inducible VT/VF
➖LVEF<35% non-ischemic, NYHA 2/3

➖LVEF<35%, NYHA 2-4, QRS>150 ms in LBBB

And more:
7️⃣ Advanced therapies for patients with Stage D #HeartFailure includes mechanical circulatory support as bridge-to-transplant/decision or destination therapy, heart transplantation, and/or palliative care
8️⃣ Misc:
➖ SGLT2 inhibitors in patients with HF and DM (EMPA-REG & CANVAS)
➖ Optimization of HF therapies that work are underutilized (CHAMP-HF:
➖ Improved insight in mechanism will improve therapies for HFpEF

TreatHF app:…

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