Outcomes/epi Flashcards
4 performance measurements
Lvef documentation, ace/arb, dc instructions, smoking cessation
What Pm make a difference in outcomes?
Ace inhibitos and beta blockers
Evidence based interventions to reduce 30 d rehospitalizations
Education, discharge med programs, discharge planning, appointments, home visits
What are results of early follow up after discharge
Decrease 30 day readmission
Serial measurements of bnp reccomendation
2b
How often is troponin elevated in HF
24%
Greater than .2 associated with high mortality
What does galactin predict
Negative remodeling
St2 prevents hypertrophic and fibrosis
What is the mortality associated with stage a heart failure
5% per year. Half of symptomatic HF but 5x Normals
Risk factors for heart failure
Biggest risk: hypertension (>140) and myocardial infarction.
Diabetes biggest risk for women
What percent of HF is stage b
35%
Jnc goals
<140/90
If diabetic 130/80
Htn treatment in elderly
Reduces mortality, HF and stroke risk
Goal of treatment of dm in HF patients
Hgb a 1c 7%
What stage a patients should go on ace
Diabetics plus cardiac risk factor, vascular disease, creatinine less than 2.4
Cad pvd or dm. Who should get statin. What LDL
all of them, doesn’t matter
Effects of beta blockers on peak oxygen consumption
Goes down
What are hfss scores/risks
Ischemic, lv ef, mean Bo, vo2, ivcd, sodium, resting hr
High risk > 8
Minnesota living with HF
Kccq
Mlhfq the higher the score the worse
The kccq from worst to best.
Rough estimate of incidence of heart failure
.5 percent
Lifetime risk of HF at age 40
1/9 men
1/6 women
Prevalence of heart failure in Medicare benefit
12 %
Risk of developing overt HF in Solvd?
10% Annually
Prevalence of stage b HF ( percent of total)
35%
How many people in the us have heart feature
5.8 million
What chronic diseases impact incidence of heart failure?
Diabetes, metabolic syndrome
Micro vascular macro
Tight glycemic control only affects micro
Hope
ace inhibitor vs placebo
Vascular disease or dm and a cardiac risk factor
23 percent arr, 2% rrr
What are best enpoints
Outcomes> symptoms> surrogates
Difference in v waves in ra vs wedge tracing
V waves in tp in rap
Closer to p wave in wedge
Ra tracing in restrict/constrict
M or w pattern.
Bio markers that predict mortality
Cro, Uric acid, sodium, rdw, creatinine, cystatin, bnp
