AHF - Discharge from ICU to the Regular Ward.

1. Acute Heart Failure
ICU to the Regular Ward
Mihai Gheorghiade MD, FACC
Professor of Medicine and Surgery
Director of Experimental Therapeutics
Center for Cardiovascular Innovation
Northwestern University Feinberg School of Medicine, Chicago, Illinois

2. Conflict of InterestConflict of Interest
Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma
AG, Cardiorentis Ltd, CorThera, Cytokinetics, CytoPherx, Inc,
DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria,
Intersection Medical, INC, Johnson & Johnson, Medtronic, Merck,
Novartis Pharma AG, Ono Parmaceuticals USA, Otsuka
Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein
Design Laboratories, Sanofi-Aventis, Sigma Tau, Solvay
Pharmaceuticals, Sticares InterACT,Takeda Pharmaceuticals North
America, Inc and Trevena Therapeutics; and has received signficant (>
$10,000) support from Bayer Schering Pharma AG, DebioPharm S.A.,
Medtronic,Novartis Pharma AG, Otsuka Pharmaceuticals, Sigma Tau,
Solvay Pharmaceuticals, Sticares InterACT and Takeda
Pharmaceuticals North America, Inc.

3. • Millions of patients are hospitalized with HF (80% have chronic
HF).
• Majority are hypertensive or normotensive at presentation.
• Vast majority improve with diuretic therapy and discharged with
minimum signs and symptoms.
• Despite robust in-hospital improvement and provision of guideline
direct therapy, post-discharge mortality and hospitalization are as
high as 15% and 30%, respectively, within 60 to 90 days post-
discharge.
• Approximately 50% of patients have preserved EF for which there
are no evidence-based therapies.
• Post-discharge event rate has not changed in the last 15 years.
ACUTE HEAR FAILUREACUTE HEAR FAILURE
TheThe Unmet NeedUnmet Need

4. Worsening Chronic Heart Failure:
The Major Reason for HF
Hospitalizations
Worsening chronic
heart failure (75%)
De novo heart
failure (23%)
Advanced/ end-stage
heart failure(2%)
Fonarow GC. Rev Cardiovasc Med. 2003; 4 (Suppl. 7): 21
Cleland JG et al. Eur Heart J. 2003; 24: 442

5. Characteristics of Hospitalized Heart
Failure (HHF) Patients
Median age (years) 75 Atrial Fibrillation 40%
Women >50% Renal abnormalities 30%
Hx of CAD 60% SBP >140 mm Hg 50%
Hx of Hypertension 70% SBP 90-140 mm Hg 45%
Hx of Diabetes 40% SBP <90 mm Hg 5%
.
Data on approximately 200,000 patients
Gheorghiade and Braunwald JAMA 2011

6. Prognosis Following Hospitalization
EVEREST - HHF TRILOGY - ACS
Both registries and clinical trials highlight the unmet
need in new therapies for patients hospitalized for heart failure.

8. 88%
6% 6%
10%
3% 1%
10%
Most Common IV Medications

27. ICU Pre-Discharge
Assessment
• Physical exam (HR, rhythm, BP)
• Laboratory data (renal function, serum
sodium, BNP, troponin)

32. Conclusions
• Majority of patients admitted with HF
responds to standard therapy and do not
need ICU stay
• Need to develop criteria for ICU
admissions and discharge