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Congestive Heart Failure Outlook Still ENCOURAGING: Remains a HOT topic for ACC 09

Apr 2, 2009 07:36 EDT


  Not until I sat down to enumerate the number of CHF related ACC topics did I understand just how many trials were presented this year that could potentially impact our practices.  For excellent commentary and insight on these presentations provided by Dr. Clyde Yancy, the AHA's 2008-2009 president elect, please watch for the upcoming Heart Failure segment on the Cardiology show.

Just to give you a preview:  The peptide Vaodilator Relaxin was utilized in acute heart failure in a dose finding study.   REVERSE ,  a European trial in which CRT was utilized in mild heart failure patients demonstrated a benefit.  We discussed the STITCH trial and whether there are truly STITCH patients still out there who should not be orphaned by a trial that did not distinguish between dykinesia and akinesia. I was particularly excited about the new LVAD, Ventrassit and its durability and broader application to other chest dimensions.  Fix-HF 5 taught us a new phrase, cardiac contracility modulation which hints at yet another device driven application for reducing CHF symptoms and PRIMA questions the utilization of using proBNP in our post discharge acute HF patients.  Another trial proved that  cancer patients treated with anthracyclines are NOT being referred for timely echocardiography and worse yet, not being treated with beta blockers EVEN WHEN they already have baseline LV dysfunction.  We need to speak to our oncolocy colleagues about that.

I commented to Dr. Yancy that in the old days, I dreaded to go to the bedside of a CHF patient.  Besides fluid and sodium restriction, there was only Lasix and perhaps nitrates and hydralazine to offer.  Now, I actually look forward to going into those rooms, rolling up my sleeves as I walk. 

I'm amazed at how far we have come. The ACC 2009 gives us a window into the future of how far we may be going.

 








Your comments
Congestive Heart Failure Outlook Still ENCOURAGING: Remains a HOT topic for ACC 09
# 1 of 8
April 8, 2009 03:35 (EDT)
Tony Joseph, MD

Thank you for a good overview of what just happened in Olrando last week. We have been taught that HF is chronic, progressive, and fatal. Yes - we have come a long way since lasix and prayer were the only modalites. If ACC 2009 is a window into the future, then when you look out that window, you see hope. Even when we can see the improved technologies and medications, we are still stuck with the fact that HF is the only major CV Dx that is still increasing in incidence and prevalence. With the population demographics of the boomer generation, this will only get worse in the second decade of the 20th century.

At the Healthcare Accreditation Colloquium, we have created an organized and systematic approach the the entire care continuum of HF using a chronic disease state model. There are foud Domains of HF: Community, Hospital, Clinician, and Science. Within each Dopmain, major accomplishments are designated as Milestones. Using tools of both cultural change and process improvement, hospitals achieve Milestones by improving their care processes. Achieving 12 milestones within the Four Domains makes the hospital eligible to apply for Heart Failure Institute Accreditaiton.

 Vist the Colloquium's website: http://www.thacinc.com

 Tony Joseph, MD

 

# 2 of 8
April 9, 2009 04:45 (EDT)
Melissa

Tony

thanks for taking the time to post your link and your commentary.  I thanked you on the wrong blogg earlier, but still a sincere thanks from me to you.

We must search for opportunity rather than accept defeat with this disease process.

Melissa 

# 3 of 8
May 7, 2009 10:36 (EDT)
Toiny Joseph, MD

Hi Melissa - Look for oppotunity - not accept defeat - words of wsidom for us all...

Heart Failure is a thorny problem. It is chronic, progressive, and incurable. Even so, quality and quantity of life can be increased. In our current economy there is a potential for increased human suffering if the needs of those afflicted with heart failure are not met including children and young people as well as older people. Economist Lionel Robbins claims that we must balance the “ends” with scarce “means” which have alternative uses. Do we live in a culture of scarcity? Or is the Culture of Scarcity induced by a financial community that controls capital (managerial capitalism)? The HEalthcare Accreditation Colloquium promotes a Culture of Abundance where scarcity values are not a defining feature of heart failure care and a wider range of options can be considered.

 The Colloquium starts with the human person who needs care and the caregiver(s) who give that care. From that starting point, a chronic disease state model that covers the entire continuum of care is used to create a quality improvement based accreditation process that can be used by hospitals to improve care while being good financial stewards and leads to accreditation as a Heart Failure Institute
# 4 of 8
May 8, 2009 06:07 (EDT)
Melissa

Tony,

I agree.  I'd like to add however, that we still aren't doing a very good job with the basics of heart failure management.  About 90% of the patients suffering from "refractory" edema offer this to me upon consultation :"doctor, I'm doing my best.  I drink all day long to try to flush this fluid out of my system". 

At least in my culture, despite doing in-hospital, in-office and print based (as well as local television based) educational campaigns, many patients are still salting their foods and "flushing" their kidneys. 

If we did a better job (present company excluded I'm sure) of educating our patients on the treatment end AND if we did our job with timely AMI therapy on the  prevention end for CHF development AND improved the 50% compliance rate with therapy, our nation would be wealthier and our patients happier . 

A simple conversation with these patients could result in improvement in both  Quality and Quanity of life.  Our nation should lead a national campaign targeting the lay public. Direct marketing to patients is now warranted because despite our knowing what to offer these patients with regard to  basic information, it isn't being delivered. 

Melissa

# 5 of 8
July 20, 2009 05:18 (EDT)
Twockin
Cannot Find Track...Help please
# 6 of 8
July 20, 2009 08:53 (EDT)
Barhocker kaufen
Barhocker kaufen Hallo, unter http://www.bar-hocker.com fand ich schöne Barhocker mit Gasdruckfeder. Die echten Designerteile kosten ja bis zu 500,- Euro und da geht es schon bei 69,- Euro los. Hat schonmal jemand von Euch da bestellt? Barhocker CU, Barhocker Design Ich fand noch: Sunrise GmbH aus Frankfurt erweitert Sortiment Frankfurt, im November 2007: Die Sunrise GmbH, der Spezialist für Dekoration und Einrichtung, hat Design Barhocker in sein Sortiment aufgenommen. Die eleganten Barhocker sind in edlen Farbkombinationen und Materialien erhältlich. Ein echter Hingucker für Frühstücks- oder Hobbybar! Trotz Ihres eleganten Äußeren und der hochwertigen Verarbeitung bleiben die Sunrise Barhocker erschwinglich. Denn auch in diesem Fall kann die Sunrise GmbH Ihre günstigen Einkaufspreise weitergeben. Je nach Modell und Kombination mit Theke werden durch einen Barhocker unterschiedliche Stimmungen im Raum erzeugt. Ein Barhocker lockert die Frühstücksecke auf, verwandelt einen Kellerraum in eine Location oder bringt Bar-Atmosphäre in das Wohnzimmer. Mit keinem anderen Stuhl wird lässige Eleganz so eindeutig assoziiert. Dabei sind die schlanken, hochbeinig konstruierten Barhocker echte Klassiker, nahezu zeitlos und in fast allen Ländern der Welt zu Hause. Schon in den Saloons des Wilden Westens lehnten die Cowboys nicht nur lässig an der Bar, sondern tranken Ihren Whisky auf einem Barhocker gestützt. In den Pariser Bars der wilden Zwanziger Jahre gehörten Sie genauso zum Inventar wie später in den Bars der Filmklassiker wie Casablanca und James Bond. Als Einrichtungsgegenstand jenseits der Bars ist der Barhocker längst Teil eines modernen Lifestyles geworden. Der Sunrise Barhocker bietet neben seinen dekorativen Eigenschaften auch ergonomische Vorteile gegenüber anderen Sitzmöbeln. Durch seine niedrige Lehne kann der Sitzende entweder lässig Platz nehmen, oder seinem Rücken ein kleines Training bei aufrechter Haltung geben. Darüber hinaus spart der Sunrise Barhocker noch richtig Platz: mit ihm bekommen mehrere Gäste problemlos auf engem Raum eine bequeme Sitzmöglichkeit geboten. Die Sunrise Barhocker sind stufenlos höhenverstellbar durch eine Sicherheitsgasdruckfeder. Die Sitzschalen der Barhocker sind in den Materialien Holz, Leder oder hochwertigem Kunststoff gefertigt. Auf alle Sunrise Barhocker gewährt die Sunrise GmbH zwei Jahre Garantie. Dazu sind sie außerdem bis zu 70% günstiger als im Möbelhaus. Die Sunrise GmbH vertreibt Kunstpflanzen und Dekorationsartikel hauptsächlich über das Internet und Katalogversand. Sie ist auf die Herstellung von Kunstpalmen spezialisiert. Sitz der Sunrise GmbH ist Frankfurt am Main. Gegründet wurde sie 1984 von Niko Jordanov. Die Internetadresse des Sunrise Online-Shops lautet http://www.bar-hocker.com.
# 7 of 8
July 23, 2009 11:15 (EDT)
Tony Joseph, MD

Today Elaine Greer covered this topic in her webinar, "Success in the Journey." See=> http://www.thacinc.com/documents/ColloquiumSummer09_Newsletter.pdf

Often it is the compassion of the nurse that engages the patient in the trerapeutic process. The heart failure nurse accepts the patient just the way they are - this then allows the patient to accept themselves, just the way they are - and from this acceptance springs hope.

 The recent AAHFN meeting brought me into contact with man such expert nurses. Compassion with a core of technical expertise.

 My hope is that everyone with heart failure would have someone like Elaine Greer to attend to their needs.

Tony Joseph, MD

# 8 of 8
July 24, 2009 08:33 (EDT)
Melissa

Bravo Tony.  Our nurses, RNP's and PA's are not lauded enough!!!

Thanks for sharing

Melissa


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About Dr Melissa Walton-Shirley
Dr Walton-Shirley performs invasive cardiology, nuclear cardiology, and stress echocardiography in a private practice in Glasgow, KY.

Her chief medical interests are CHF/hypertrophic obstructive cardiomyopathy and the promotion of primary PCI for acute MI. Recently she played a significant role in helping to launch an ambitious pilot study of primary PCI in Kentucky, the Kentucky Primary Angioplasty Pilot Project. She has also participated in the TIMI 19, Duke-HF, NRMI, and CRUSADE trials and is proud to have been an advocate of the first smoke-free initiative in Kentucky (2011). She champions a smoke-free America.

Dr Walton-Shirley received her undergraduate degree at the University of Kentucky and went to medical school and did her residency and fellowship at the University of Louisville. She is married with two daughters. Her interests include singing, writing poetry and songs, fitness, and, of course, theheart.org.