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La ricerca nello scompenso cardiaco acuto: ci sono reali novità? Aldo P Maggioni Centro Studi ANMCO Firenze.

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Presentazione sul tema: "La ricerca nello scompenso cardiaco acuto: ci sono reali novità? Aldo P Maggioni Centro Studi ANMCO Firenze."— Transcript della presentazione:

1 La ricerca nello scompenso cardiaco acuto: ci sono reali novità? Aldo P Maggioni Centro Studi ANMCO Firenze

2 Lepidemiologia dello scompenso acuto rimane un problema rilevante senza segni di miglioramento nel tempo

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7 AHF vs CHF outcomes Lee DS, Am. J. Med. 2004

8 La ricerca sui trattamenti dello scompenso cardiaco acuto Fallimenti Semidelusioni Piccoli successi

9 Sopravvivenza dei farmaci per lo S.C. grave Xamoterolo 1990919293949596971998 Milrinone (PROMISE) Vesnarinone (VEST) Ibopamina (PRIME-2) Pimobendan Flosequinon Epoprostenol Bosentan (First) (REACH-1)

10 La ricerca sui trattamenti dello scompenso cardiaco acuto Fallimenti Semidelusioni

11 Euro Heart Survey - ESC congress, Vienna, September 2007

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13 A. Mebazaa et al., JAMA 2007, 297: 1883-1891

14 Euro Heart Survey - ESC congress, Vienna, September 2007 A. Mebazaa et al., JAMA 2007, 297: 1883-1891 BNP A. Mebazaa et al., JAMA 2007, 297: 1883-1891

15 Euro Heart Survey - ESC congress, Vienna, September 2007 A. Mebazaa et al., JAMA 2007, 297: 1883-1891

16 La ricerca sui trattamenti dello scompenso cardiaco acuto Fallimenti Semidelusioni Piccoli successi

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18 M.A. Konstam et al., JAMA 2007, 297: 1319-1331

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20 Per cominciare a ragionare più seriamente E possibile fare una stratificazione dei rischi affidabile ?

21 Euro Heart Survey - ESC congress, Vienna, September 2007

22 EHS HF II: data collection Patients screened at the emergency area, including cardiac care unit (CCU) or intensive care unit (ICU), as well as on ward facilities (internal medicine or cardiology) 133 participating hospitals: university hospitals (47%) community or district hospitals (49%) private clinics (4%) 30 European countries Recruitment from 21 October 2004 until 31 August 2005

23 Euro Heart Survey - ESC congress, Vienna, September 2007 EHFS II: All-Cause in-Hospital Mortality 6.6% 39.6% 5.3%5.4% n. 3580 ptsn. 139 ptsn. 2202 ptsn. 1239 pts

24 Euro Heart Survey - ESC congress, Vienna, September 2007 Univariate analysis: in-hospital mortality by age, SBP and creatinine at hospital entry <6565-80>80>130110-130<110<1.41.4-2.0>2.0 3.0% 5.1% 9.3% 3.4% 5.7% 10.8% 3.4% 6.4% 12.9% (n. 3441 patients)

25 Euro Heart Survey - ESC congress, Vienna, September 2007

26 EHFS II: All-cause in-hospital mortality by strata of risk score Risk score N. of pts 772 743 726574305321

27 Per cominciare a ragionare più seriamente E possibile fare una stratificazione dei rischi affidabile ? Quali end-point e a quali tempi dobbiamo misurarli ?

28 Euro Heart Survey - ESC congress, Vienna, September 2007 Chronic HF ACS All-cause mortality: The lessons learned from trials and registries... Acute HF Opasich C et al. for the IN-CHF Investigators. Am J Cardiol 2000; 86: 353-357 GISSI-3: Six-month data. J Am Coll Cardiol 1996; 27: 337-344 Tavazzi L et al. The Italian survey on Acute Heart Failure. Eur Heart J 2006; 27: 1207-1215

29 Research in acute HF: Conclusions Morbidity and mortality of patients with acute HF remain unacceptably high Treatment of acute HF continues to remain largely anecdotal without much progress in the last decades Risk stratification with the identification of simple clinical variables seems to be feasible in any clinical setting In any case, the application of risk scores in the real world of acute HF could be limited by: The heterogeneity of this clinical condition The different patho-physiological background The various clinical settings (and doctor profiles) in which patients with AHF are managed Further efforts should be focused on planning research in the field of AHF

30 What do we need ? Data on the clinical characteristics. Definition, sub-clasification (ST /non-ST ) Data on the exact pathophysiology of each subtype. Better ways to risk-stratify the patients. Treatments to: Reduce Mortality Reduce Morbidity (worsening heart failure?) Rapid and safe symptoms relief Or in other words … everything…

31 Comparison of decompensated heart failure with acute myocardial infarction Decompensated Acute myocardial Heart failure infarction Hospitalization per year(in US) 1,000,000 1,000,000 In-Hospital Mortality3-12%3-7% Readmission rate (60 days)35%10% Guidelines for risk stratificationNoYes Guidelines for therapyYes (ESC) Yes No (AHA/ACC) Largest randomized trial4,13341,021 MEDLINE citations (1965-2006)47233,908 Modified from Am Heart J 2003; 145: S18-25


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