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Host:

• Bob Underwood, MD
  • Emergency Physician

Guests:

• Deepak Bhatt, MD, MPH
  • Director of Mount Sinai Heart
  • Inaugural Dr. Valentin Fuster Professor of Cardiovascular Medicine
• Erin Michos, MD, MHS
  • Director of Women's Cardiovascular Health Research
  • Associate Director of Preventive Cardiology at Johns Hopkins University
  • Co-Director of the Impact Center at Johns Hopkins University
  • Co-Editor in Chief of the American Journal of Preventive Cardiology

Supported by:

• Independent educational grant from Merck, Sharp, and Dohme

Episode Overview:
In this episode, the panel discusses the diagnosis, prognosis, and progression of worsening heart failure, along with new diagnostic techniques and treatment strategies. They highlight the disparities in heart failure outcomes and the importance of early detection and treatment.

Key Takeaways:

• Epidemiology of Heart Failure:
  • Around 6.7 million Americans have heart failure, and this number is increasing.
  • Heart failure is often referred to as an epidemic due to its prevalence and poor prognosis.
• Disease Progression:
  • Heart failure progresses through four stages (A-D). Worsening heart failure occurs when patients experience increasing symptoms despite optimal treatment.
  • Half of the cases involve preserved ejection fraction (HFpEF), and the other half involve reduced ejection fraction (HFrEF).
• Prognosis of Worsening Heart Failure:
  • Prognosis is poor, with a five-year mortality rate of 50%. Worsening heart failure can increase mortality rates threefold and hospitalizations sixfold.
• Diagnosis:
  • Worsening heart failure is often diagnosed through acute cardiovascular care needs, such as hospitalization or intravenous diuretics.
  • Biomarkers like BNP or NT-proBNP, echocardiograms, and imaging techniques aid in diagnosis.
• New Diagnostic Techniques:
  • Point-of-care ultrasound (POCUS) and imaging methods like echocardiograms can detect systemic venous congestion and pulmonary edema, providing valuable insights into heart failure progression.
• Role of Ejection Fraction:
  • Ejection fraction (EF) helps categorize heart failure and guides treatment. New categories such as mid-range EF (41-49%) are emerging.
  • Despite some limitations, EF remains an important tool for diagnosis and treatment decisions, though future advancements like AI could provide more precise categorizations.
• Looking Ahead:
  • Upcoming episodes will explore the role of monitoring devices in heart failure management, including invasive and non-invasive technologies.

Next Episode Teaser:
The discussion continues with a focus on monitoring devices and their role in heart failure management, as well as the future integration of AI in diagnostics.

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