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Cardio Diabetes Medicine 2017 457

Heart Failure: Drug Thaerapies and

Revascularization Strategies

Dr. Abraham Oomman
M D, DM (Cardiology), DNB (Cardiology),
MNAMS, FACC, FESC, FSCAI,
Senior Consultant Interventional Cardiologist
Apollo Hospitals, Chennai

Introduction tolic dysfunction - IIa A
Heart failure is the modern day plague with a 5 year BB in asymptomatic LVD and h/o MI - I B
mortality over 50% , deadlier than most cancers ex-
cept possibly lung cancer. It is common , costly and ICD in asymptomatic LVD (EF < 30%), ischaemic 40
deadly. Its prevalence is 2-3% and is the number one days after MI - I B
cause of hospitalizations in patients over 65 years. ICD in asymptomatic non- ischaemic DCM (EF < 30%)
Heart failure expenses in USA annually is nearly 40 on OMT - I B
billion dollars annually. Prevention, diagnosis, risk
stratification, monitoring and managing heart failure Acute Heart Failure
is challenging. ESC 2016 mang ement algorithm is given below (pic
There is a rising prevalence of heart failure in India 1, 2,)
due rising incidence of hypertension(HT), diabetes
mellitus (DM), obesity and coronary artery disease Main messages in AHF
i(CAD). The AFAR study on the epidemiology of In AHF with no shock ,decongestion with vasodilators
acute decompensated heart failure (ADHF) in India to be initiated. Low CO with myocardial ischaemia
noted that there is a significant difference from the tackle myocardial ischaemia urgently. Time is muscle.
Western data( OPTIMIZE registry). Mean age was 2 Combine inotropes with norepinephrine if needed.
decades earlier (53.5 vs 73.1),the in-hospital mortality Avoid epinephrine as much as possible.
was 30.8% vs 3.8%, post discharge 6 month mortality
was 26.3% vs 8.6% and 6 month combined mortalty Main messages in AHF
and rehospitalizatiion was 39.5%.
In AHF with no shock ,decongestion with vasodilators
to be initiated. Low CO with myocardial ischaemia
Recommendations to prevent or delay the tackle myocardial ischaemia urgently. Time is muscle.
onset of HF(ESC 2016) Combine inotropes with norepinephrine if needed.
Treat Hypertension - I A Avoid epinephrine as much as possible.
Statins for those with or high risk of CAD I A Management algorithm is given below of Symptomatic
chronic heart failure (ESC2016)
Counselling and treatment for smoking cessation
and alcohol reduction - IC
Pharmacotherapy in HFrEF
Treat other RF (obesity, dysglycemia) - IIa C The objectives in the management of HFREF are

Empagliflozin in T2DM - IIa B reduction in mortality, improve clinical status,
functional capacity, quality of life and reduce re-
ACEI in asymptomatic LV dysfunction with h/o MI I A
admissions. There has been a steady improvement
ACEI in asymptomatic LV dysfunction without h/o in mortality reduction in CHF management.
MI I B

ACEI in stable CAD even if they do not have LV sys-

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