What’s New in 2023 in the Management of Heart Failure?
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- Опубліковано 17 кві 2023
- The field of cardiology is well known for rapidly synthesizing the evidence from new and cleverly named clinical trials into diagnostic and therapeutic guidelines. The latest updates in guideline-directed medical therapy (GDMT) reflect the remarkable advances in management of one of the most common reasons for hospitalization: congestive heart failure (CHF). At our next Medicine Grand Rounds, Jonathan Davis, MD, director of the Heart Failure Program at ZSFG, will review the latest guidelines for treatment of heart failure, focusing on the 2022 ACC/AHA/HFSA Guidelines.
Speaker:
Jonathan Davis, MD, is associate professor and director of the Heart Failure Program in the Division of Cardiology at ZSFG. He is the recipient of the 2020 Henry F. (Chip) Chambers, MD Medicine Subspecialist Consultant of the Year Award. Jonathan was born and raised in San Francisco and attended medical school and internal medicine residency at UCSF. He continued on faculty as a Congestive Heart Failure service hospitalist and then completed fellowships in Cardiology, Advanced Heart Failure and Transplant Cardiology at Washington University in St. Louis. He then served as medical director for Mechanical Circulatory support at OHSU and was recruited back to ZSFG in 2018. He is a clinically renowned cardiologist and his research focuses on innovative care systems to reduce admissions for heart failure.
Note: Closed captions will be available within 48-72 hours after posting.
Program
Lekshmi Santhosh: Introduction
00:01:47-00:54:25 - Jonathan Davis, MD, associate professor and director of the Heart Failure Program in the Division of Cardiology at ZSFG
00:54:41-1:03:24 Q&A
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Thank you. Forxiga has saved my life. I spent, literally, years in bed. I’m now a normal Senior Citizen, a bit slow but able to be out and about.
Im so grateful for people like you, Doctors/scientists. With so much chaos in the world it's important to know, not only for the actual patients but also for world morale, that theres human beings out there trying to save lives and fighting to keep people alive as opposed to taking lives.
Great lecture, greetings from Cayetano Heredia, Lima Peru
Great great lecture , I am glad I sit through it , despite a few break in in between this is the wonder of modern day , one can watch UA-cam and get educated despite , not from prestigious institutions! Thank you very much Doctor and Doctors and UCSF.
Nice lecture and great job covering GDMT in detail! and I liked your in-depth real-world scenarios dealing with the initiation of various meds. Really found it helpful :)
Thank You for this great brief!
I pray this is in simply English! Just finished a 5 spot Afib Surgery, I’m having trouble recovering from.
Where is a Heart Failure Clinic??? I live out side Brunswick, GA. No such thing. Went to a surgeon who didn’t talk to me before or after emergency surgery. I’m 71, look 65.
It’s been two weeks!! It’s shocking! I’ll be dead soon. I have no other medical things but being 40lbs overweight at 5’8” due to Lockdown Eating.
Listening to you, just getting out after three weeks and now Home Health and PT. You are soooo right. I am worse post surgery!
Oh my! This is far far worse than I thought. But no one tells the real truth! It’s all soft pedaled.
I’m on a fistful of pills, still feel just terrible!
Have been weak and ill since January 2022. No one found anything. No one has given me a diagnosis except Congestive Heart Failure.
I give up! May it be fast, have DNR! Thanks!
Can you see if you can travel to a clinic? Call the largest city near you or a Mayo clinic for help? Or write down the 4 medications recommended here and see if your doc will give to you? I just had HA, 5 stents, CHF… dont feel great and have tried my adult life to stay off meds but not now…72 now..dealing with side effects, but am willing to take these meds, my Cardio put me on all but 1…live in bay area,SF where this doc works
Great talk thank you
Great lecture!!!
Excellent presentation, TY. I'll definitely have to watch a few times!
What a great explanation and so well presented in language I can understand as a patient - thank you so much!
And yes I’m on all four - although I’m trying eplerenone rather than spironolactone as the male Gynecomastia is a very real side effect. Also trying trulicity over jardiance but the digestive upsets are impacting quality of life too much so I will switch back in the near future also no real weight loss to speak of. Digoxin has also helped with my exercise tolerance and torsemide keeps water retention within good limits as long as my sodium intake is less than 1500mg pd. Lightly Exercise for 30m on stationary bike and walk dogs for an hour or so in nature every day makes life lovable.
Outstanding indeed.
Dr. Davis, I am 82 years old and was diagnosed with HF 2 years ago. Also I reside in the Caribbean so access to second opinion is quite limited. I was prescribed Carvedilol, Losartan, Eplerenone, Clopidogrel Fuoresemide, and Amiodarone. I am also taking Jardiance and stopped taking the Fuoresemide due to constant dehydration. My ejection fraction was 46%. Without the meds I would occasionally have some hyperventilation and initially I had AFIB which responded well to meditation.
My questions are about 2 things mainly: Jardiance, which I asked my cardiologist to prescribe for me when I saw him 5 weeks ago. I have heard nothing and decided to get Rx for Jardiance from a GP. I also asked my cardiologist his opinion of ARNI, but I had no response.
My house has 3 flights of stairs and I use them 2 or 3 times a day with no issues (never had a problem). I walk 3 or 4 days /wk for minimum 30 minutes each time, garden often; sleep with no pillows due to post-nasal drip, occasional minor edema at ankles.
I understand your limitations in answering, but I would greatly appreciate your opinion and I would talk to my doctor before proceeding.
Thank you….
What about supplements for heart failure nothing is mentioned about coenzyme, magnesium ,Hawthorn, etc
My only concern re this fine discussion, is no mention re the dietary contribution for improving the body’s systems to deal with the impact of medications on the efficiency of system to recover…or is there a way to lose weight when so many meds seem to be making digestion, physical movement more challenging
An ongoing CHF study at Stanford University shows that patients are not willing to weigh themselves every day for multiple reasons, including they are embarrassed to see how much they weigh. The solution is simple...continuous monitoring of ankle circumference which is a DIRECT measure of fluid retention.
But not everybody holds their fluid there. Better education is needed on the subject, as to why we look at weight or maybe reduce the frequency
Eye-opening💉🙏🏿
Thank you so much Doctor. Excellent intervention. Im 59 years old diagonised with HF EF at 35, met my doctor and on highest dosage of Uperio( Entrestor) and all the other drugs you mentioned. I feel great now than previously. However, life expectancy is 6 and half years is scary. I want stay alife and healthy upto 80 years. What should do to improve on my health, please?
fasting 16 hours a day and exercising 6 days a week . Your heart is a muscle
Please comment on the other drug we are pumped with. Statins. I read that cholesterol levels as low as possible is the best. I also read that its old studies that were far from accurate and quite false.
What is your take on interatrial septostomy in patient with Heart failure with preserve ejection fraction.
Just because someone can, it doesn't mean they should. Treat the underlying cause... don't attempt to patch the disease. Unless maybe you're referring to HOCM.
When talking about diabetes you Need to specify TD2 not TD1 unless things change?? will they revise?
What about Barostim?
Every effort should be made to have wide spread cardiac rehabilitation program in the community, and that is trough made it provided as sessions in every jim center and very cheap whether included as free or paid as salsa or Zomba sessions!
Physicians volume is increasing, leasure time is increasing, and nothing more pleasurable than helping patients and consider them as part of your pleasure time!
If the heart is considered rhe controller station of the approved programed function of every organ in the body whether through autonomic nervous system or directly, then every point in the heart represent fraction of organ, and thus updated heart mapping per body organs has to be uncovered in UCSF❤.
Knowing the new heart map will have impact on curing all diseases whether cardiac - specific, or organ- specific, or system- specific human encounter giving the fact that we failed as scientists and physicians with those limited medications available to cure cardiac diseases!
What this physician is mentioning is just a retrospective data of what was happened to those patients with failing hearts!
Marwah Zahaf MD Msc
What's your suggestion on easing the symptoms of hf?
Great.thak you. One question, if the EF improved , can we stop one or two of the drugs ( MR and b blocks). Any study answering this quitions
28:47
Dont stop the medications as in the talk above !
Nope
TRED-HF suggested that stoppage of medications resulted in a slow reduction in EF
Kb aayegi reverse karna ki treatment
I am on 52:35 ❤met
nsaids gave me heart failure
How so?
@@bakokat6982they cause sodium and fluid retention
Curing patients is bad for business.
Please tell us about your cure Mrs Kruger
Another entresto infomercial, how sad