如何避免慢性心力衰竭恶化.ppt

TohruIzumi,ToshimiKoitabashi,MototsuguNishii,TakayukiInomataDepartmentofCardio-Angiology,KitasatoUniversitySchoolofMedicine,Sagamihara288-8555,JapanOct23rd,2008,Beijing,HowtoPreventFromWorseningofChronicHeartFailureThe4thChina-JapanCardiovascularForum(CJCF)

ChronicHeartFailureand

DiseaseBurden

BurdenAgingCVEventCVEvent

BNPguidedtherapyforCHFpatientReductionofcardiacevent(diseaseburden)Indicator:BNPCHFACEI+BBTxComprehensivemanagementDiuretics

０１８４０１００２００５００pg/mLＢＮＰscale*PlasmaBNPlevelistitratedbyRIAusingShionoria(Shionogi,Osaka)

Afterdischargewith/withoutBNPguidedFollowupperiodafterdischarge(days)1.00.60.800.20.40200400600Cardiac-event-freesurvivalClinicalguidedTxBNPguidedTxp=0.0435readmissionrate365days16.6%31.5%?Intwoyearsfollow-up,thereweresignificantlylowercardiacevents,readmission,inBNPguidedTxincomparisonwiththeclinicalguidedTx.Cumulativerateoftheeventwithinoneyearreducedfrom31.5to16.6%.InomataT,etal.JpnCircJ2001;65(S-1A),282.

GroupIGroupIISRSRAfAfKoitabashiT,InomataT,etal.ESC2004BNPguidedTxcancelledoutprognosticcontributionbyAFinCHFmanagementAlteredprognosisofAfPtsbyintroducingBNPguidedTxHF-event-freesurvival(%)GroupIIBNPguidedera(‘00-02)GroupIClinguidedera(‘96-98)SRgroupAfgroupFollow-upperiod(month)200pg/mL≥200pg/mL

Eventfreesurvival0.00.10.20.30.40.50.60.70.80.91.00102030405060708090Follow-upperiod(months)Eventfreesurvival0.00.10.20.30.40.50.60.70.80.91.00102030405060708090Follow-upperiod(months)P0.0001TotaldeathArrhythmiceventsBNP100pg/ml,n=213BNP≧100pg/ml,n=176P=0.0028BNP100pg/ml,n=213BNP≧100pg/ml,n=176BNPandArrhythmicPrognosisKITASATOUNIVERSITY

Cost-effectivenessofBNPgTxQALY(qualityadjustedlifeyear)YearsCosts＄＊＊＊MorimotoT,IzumiT,FukuiTetal,IntJCardiol,2004

ClinicalIndicatorCheckPointforCHFManagementDry+WarmBNP200NewIndex?Hospital