心力衰竭管理发展历程.ppt

ManagementofHeartFailure:Past,PresentandFutureLexinWang,M.D.,Ph.D.,FCSANZProfessorofClinicalPharmacologyHead,CardiovascularResearch

Objectives

HistoryandpathogenesisEpidemiologyandriskfactorsCurrentmanagementFuturedirections

Katz,A.M.CircHeartFail2008;1:63-71WilliamHarvey,1628

Katz,A.M.CircHeartFail2008;1:63-71Changingmanagementofheartfailureoverthepast40years

CHF-PrevalenceApproximately5.5millionAmericanshaveCHF(2.2%ofthepopulation)550,000newcasesannuallyAccountsfor12millionclinicvisitsperyearEstimatedhealthcarecostsin2004isUS$28.8billion

CHFprevalence-Australia2%ofadultpopulationApproximately241,000patients30,000newcaseseachyear42,000hospitalisationsin2004-2005Accountsfor0.8%ofallhospitalisationsinthecountry

Age-relatedprevalenceofCHF

AmericanNationalHFproject34,587hospitalizedpatientsAge(median,yrs) 73Gender(female,%) 59%History(%) hypertension 61% coronaryarterydisease 56% diabetes 38% COPD 33% atrialfibrillation 30% HavranekEPetal.AmHeartJ2002;143:412-417

ClassificationofCHFSystolicCHFWeakenedabilityoftheventriclestocontractHeartfailurewithpreservedsystolicfunctionImpaireddiastolicfillingoftheleftventricle,resultinginhighfillingpressure,withorwithoutsystolicdysfunctionAccounts40%ofallCHF

ManagementofCHF

LifestylechangesPharmacologicalSurgicalDevicesCABG,PCICardiactransplantation

DrugtherapySTEP1Confirmleftventricularsystolicdysfunction(LVSD)byEchocardiographyRadionuclideventriculography,orRadiologicalleftventricularangiography

DrugtherapySTEP2Initiatefirst-linetherapyinallpatientswithheartfailureduetoLVSDwithadiureticandanACEinhibitorforNYHAclassI-IV,andabeta-blockerforNYHAclassII-III,unlessthesearecontra-indicated

DrugtherapySTEP3Initiatesecond-linetherapyinpatientswithpersistentsignsandsymptomsofheartfailure(NYHAclas