CHF Symposium

in Lubbock, Texas, sponsors an annual symposium on congestive heart failure.The summaries below provide important updates on the management of patients with congestive heart failure May 2019and dilated cardiomyopathy.Women more frequently have diabetes, anemia, and thyroid disease, whereas men more often have renal failure, peripheral arterial disease, and COPD.Such differences prompt a need to individualize management.This also underscores the need for more comprehensive recruitment of women into clinical trials.Mortality secondary to ADHF varies with the type of presentation.HF patients presenting with cardiogenic shock have the highest in-hospital mortality ranging up to 40%. 2 Hospital readmissions present a challenge in that they increase mortality. 3,4 Additionally, the Centers for Medicare and Medicaid Services imposes a financial penalty on the hospital if 30-day readmissions exceed 25%.Causes for hospital readmission are drug/diet noncompliance, failure to seek care, inappropriate drug regimen at discharge, and incomplete resolution of symptoms at discharge.ADHF may be de novo or more commonly acute decompensation of chronic HF.Triggers for acute decompensation include hypertension, acute coronary syndrome, arrhythmias, infections, renal failure, and non-compliance.Amplifying mechanisms are usually diastolic dysfunction, endothelial dysfunction, renin angiotensin and aldosterone/sympathetic activation, oxidative stress, and inflammation.End organ dysfunction and congestion become the final consequences.Brain natriuretic peptide (BNP) and N terminal pro BNP are the established markers of HF.High sensitivity troponins are now also used for risk stratification.Soluble ST2 and Galectin 3 are now FDA approved for use as biomarkers of fibrosis/remodeling and inflammation.However, there is no gold standard for diagnosis, but BNP is used to triage patients in the emergency rooms.