Congestive Heart Failure
Changing population trends
Clinical Scenario

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http://www.ziddu.com/download/7799915/CHF.ppt.html

JB is 75 and is a retired publican. First presented 12 yr ago with MI.
A strong family Hx of CVS disease. Father died at age 40 with Stroke. Mother had angina.
Subsequent LVF 5 yr ago with hospitalization. Echo dilated / asymmetrical contraction / dysynergy.
Ejection Fraction 35%. Effort Dyspnoea
What are the therapeutic options?
Congestive Heart Failure
Incidence and age
Congestive Heart Failure
Changing population trends

Combined all-cause mortality and morbidity (time to event)

Hospitalization for heart failure

Sudden death with resuscitation

Need for intravenous inotropes/vasodilators for worsening HF

All-cause mortality (time to event)

Hospitalization for heart failure

Signs and symptoms of heart failure

NYHA functional class (change from baseline)

Echocardiographic indices of left ventricular function (LVEF and LVIDd — change from baseline)

Quality of life score (Minnesota Living With Heart Failure score)

Mortality and Morbidity Analyses
Primary Endpoint Analyses
Primary Endpoint Sensitivity* Analyses
Effect of Valsartan on Morbidity Endpoint*
All-Cause Mortality:
Kaplan-Meier Analysis (Val-HeFT)*
Mortality by ACE Inhibitor/Beta Blocker Subgroups
HF-Related Hospitalizations*