Treatment and Management of Advanced Heart Failure with Dr. Peter Eckman

Ridgeview Podcast: CME Series

This podcast, Dr. Peter Eckman, a cardiologist and heart failure specialist, with Minneapolis Heart Institute, discusses heart failure and why it is an extensive medical issue.

Enjoy the podcast.

Objectives:Upon completion of this podcast, participants should be able to:

• Recognize heart failure as a problematic clinical disease and its morbidity and mortality that leads to comprehensive medical management.
• Identify and describe optimal contemporary medical therapy for heart failure.
• Describe novel options for heart failure.

This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.

CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at [e-mail].

Click the link below, to complete the activity's evaluation.

CME Evaluation

(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview. Any re-reproduction of any of the materials presented would be infringement of copyright laws.

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Dr. Eckman has disclosed a financial relationship with Abbott Labortories, Edwards Life Science, Ancora, and Daxor, and there are no conflicts of interest with this podcast presentation. No other individuals in control of content have disclosed any financial relationships, thus no conflict of interest exists with the presentation/educational event.

Thank-you for listening to the podcast.

SHOW NOTES: *See the attachment for additional information.

Heart Failure (HF)- Can occur without congestion or fluid retention - Characterized by fatigue, fluid retention, SOB, PND, orthopnea - We should consider the same urgency for heart failure as patients with CAD and CA.

Heart Failure Preserved/Reduced Ejection Fraction (HFpEF/HFrEF)- HFpEF is a Preserved Ejcetion Fraction over about 50% - HFpEF - congestive phenotype more of a fluid retention - an exercise intolerant phenotupe where the patient becomes intolerant of exercise induced dyspnea. - Pulm HTN phenotype - Increased pressure in the heart that gets transmitted to the lungs - HRrEF is Reduced EF is usually below 40%

Medications- 4 classes of medications (MRAs, BB, SGLT2, ARNIs) - Treatment with mineralocorticoid receptor antagonists (MRAs) has been demonstrated to improve clinical outcomes in patients with HFrEF with mild to severe symptoms and also in patients with left ventricular dysfunciton after myocardial infarction. - SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalizations for heart failure in a broad range of patients with heart failure, supporting their role as a foundational therapy for heart failure, irrespective of ejection fraction or care setting. - ARNI (angiotensin receptor/neprilysin inhibitor) medication is a newer treatment for heart failure. The combination of sacubitril and valsartan has helped people live longer and have a better quality of life. - Comprehensive EF therapy involves BB, ARNI, MRAs, angiotensin receptor/neprilysin inhibitors. Spironolactone, SGLT2 inhibitors.

Treatment- Traditional therapy usually involves a BB and ACE inhibitor. - Currently we should be looking at comprehensive therapy when it comes to HF treatment. - STOP USING LISINOPRIL.- SGLT2 inhibitors contraindicated ketoacidosis, amputation UTI, weight loss - (SGLT2 inhibitors) DAPA-HF trial showed that dapagliflozin was superior to placebo at preventing cardiovascular deaths and heart failure events among patients with heart failure. (Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303#article_citing_articles ) - Catheterization - a vast majority of HF patients will need a right heart catheterization. - Cardiac pulmonary pressure monitoring Cardio MEMS - same day outpatient surgery which helps with medication adjustments and hospitalization in half. Works regardless of EF. - CardioVere laser spectroscopy which uses different wavelengths to detect light characteristics to determine the level of edema/fluid present wihin someone's tissues. Currently in development. - Casana is a toilet seat with certain sensors that detect and monitor impedance that check levels between different tissues, monitors HR and weight. - Cardiac contractility modulation causing electrical stumulation during a particular contraction of the myocyets it will augment potential (like a pacemeaker). -CORCHINCH - HF trial catheter based device that cinches up the heart, thereby making it smaller. It works more efficiently. (Source: Clinical Evaluation of the AccuCinch® Ventricular Restoration System in Patients Who Present With Symptomatic Heart Failure With Reduced Ejection Fraction (HFrEF): The CORCINCH-HF Study)

Novel Treatments- Atrial shunting procedure is investigational trials. Potentially impactful in exercise capacity and pressures but stay tuned as the verdict is not out. HfPEF exercise induced intolerance may be the best candidate. - SVC trial feasibility trial more durable effects of cardiac output. Stay tuned. - LVAD for advanced therapies. Sometimes a bridge for candidacy as well as recovery. - Biventricular pacing has shown promise.

*Heart failure is a problematic clinical disease entity with significant morbidity and mortality often leading to comprehensive medical management. It is often beneficial to enlist the help of our heart failure colleagues for these complicated patients.

Thanks to Dr. Peter Eckman - MHI heart failure specialist for his knowledge and contribution to this podcast.

Please check out the additonal show notes for additional information/resources.