如何优化心衰控制？-课件，幻灯，PPT.ppt

0 1 2 3 years 0 10 20 30 40 50 Placebo Candesartan % Number at risk Candesartan 1276 1176 1063 948 457 Placebo 1272 1136 1013 906 422 3.5 HR 0.85 (95% CI 0.75-0.96), p=0.011Adjusted HR 0.85, p=0.010 483 (37.9%) 538 (42.3%) McMurray et al, Lancet 2003 CHARM-AddedPrimary outcome, CV death or CHF hospitalisation Effect of Candesartan: On top of ACEI, BB and Spironolacton Walking out from misperceptions ! No 3 Beta-blockers should be avoided in diabetic CHF patients Beta-blockers should be avoided in COPD and CHF patients Beta-blockers and ACE inhibitors should be avoided in elderly CHF patients Low dose of beta blocker /ACEI is not meningful False False False False False All beta blockers or ARB have class effects False To be creative ! No 4 Hypotension Bradycardy Renal dysfunction Hyperkalaemia Low compliance … For example Not easy, but not impossible ! Too much diuretics ? Hypotension Other vasodilators ? Symptomatic ? Time to re-consider ! Negative chronotropic drug (digitalis, CCB with low vascular selectivity ) ? Bradycardy ? Symptomatic ? Time to re-consider ! Daytime ? Evening ? At rest ? Exercise ? Pacemaker ? What shall we do when guideline does NOT exist ? 某保险业务财富赢家开发背景心肺移植的麻醉和心肺移植后非心脏手术的麻醉心律失常病人的护理医学课件北京兆宜佳汽车用品有限公司推荐书 Keep guideline in mind,  walking your own way ! Michael Fu, MD, PhD, FESC Professor, Senior Consultant Physician Head, Heart Failure Center Medicine Sahlgrenska University Hospital/Sahlgrenska G?teborg, SWEDEN How to optimize heart failure management ? Chronic Heart FailureMore common than we believe ! 2 % 10 % CHF: A aged population 0 100 200 300 400 500 600 700 1960 1980 2000 2020 Millions 165 296 403 649 Chronic Heart Failure A disease state which seldom stops ! Risk factors: diabetes hypertension Vascular dysfunction Vascular disease Tissue injury (MI, stroke) Pathological remodeling Target organ dysfunction (H