心力衰竭管理发展历程.pptxVIP

Management of Heart Failure: Past, Present and FutureLexin Wang, M.D., Ph.D., FCSANZProfessor of Clinical PharmacologyHead, Cardiovascular Research ObjectivesHistory and pathogenesisEpidemiology and risk factorsCurrent managementFuture directionsWilliam Harvey, 1628Katz, A. M. Circ Heart Fail 2008;1:63-71Changing views of heart failure 1. A clinical syndrome 2. A circulatory disorder 3. Altered architecture of the heart 4. Abnormal hemodynamics 5. Disordered fluid balance 6. Biochemical abnormalities 7. Maladaptive hypertrophy 8. Genomics 9. Epigenetics (实验胚胎学)Changing management of heart failure over the past 40 yearsKatz, A. M. Circ Heart Fail 2008;1:63-71CHF-PrevalenceApproximately 5.5 million Americans have CHF (2.2% of the population)550,000 new cases annuallyAccounts for 12 million clinic visits per yearEstimated health care costs in 2004 is US $28.8 billionCHF prevalence- Australia2% of adult populationApproximately 241,000 patients30,000 new cases each year42,000 hospitalisations in 2004-2005Accounts for 0.8% of all hospitalisations in the countryAge-related prevalence of CHF American National HF project 34,587 hospitalized patientsAge (median, yrs) 73Gender (female, %) 59%History (%) hypertension 61% coronary artery disease 56% diabetes 38% COPD 33% atrial fibrillation 30% Havranek EP et al. Am Heart J 2002;143:412-417Classification of CHFSystolic CHFWeakened ability of the ventricles to contractHeart failure with preserved systolic functionImpaired diastolic filling of the left ventricle, resulting in high filling pressure, with or without systolic dysfunctionAccounts 40% of all CHFManagement of CHFLife style changesPharmacologicalSurgicalDevicesCABG, PCICardiac transplantationDrug therapySTEP 1Confirm left ventricular systolic dysfunction (LVSD) by EchocardiographyRadionuclide ventriculography, or Radiological left ventricular angiography Drug therapySTEP 2Initiate first-line therapy in all patients with heart failure due to LVSD witha di