The Effects Of Coronavirus Pandemic Lockdown On Patients With Chronic Heart Failure
HFSA ePoster Library. Kammoun I. 09/10/21; 343503; 267
Ikram Kammoun
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Abstract
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Introduction: Heart failure with reduced ejection fraction (LVEF) has a high prevalence and high rates of mortality and morbidity.
Methods: Data collection was performed in heart failure clinic, and retrospective information was gathered at the electronic medical record.
Case: A 79-year-old man with dilated cardiomyopathy of ischemic etiology, hypertension, chronic kidney disease undergoing conservative treatment, history of stroke, was hospitalized due to HF decompensation, with hemodynamic profile B, NYHA III, 4 years ago. The patient had a history of frequent hospitalizations (3 in the last year). Echocardiogram revealed LVEF 10% (Teicholz) and 24% (Simpson) and myocardial scintigraphy with GATED 8%. There was no adequate response to drug therapy (Carvedilol, Enalapril, Furosemide and Digoxin) optimized, and cardiac resynchronization therapy was chosen. Five months after installing the device, the patient developed pneumonia, which resulted in further decompensation and hospitalization. We chose to start Sacubitril / Valsartan (24/26mg twice a day). Sequentially, there was a gain in functional class, reaching NYHA I, despite maintaining significant ventricular dysfunction [LVEF 20% (Simpson), 22% (Teicholz)]. There were no new admissions in the last 36 months, and the patient is still NYHA I.
Conclusion: Despite the association between LVEF and mortality, the functional class represents a more accurate risk marker than LVEF. In the case described, the excellent clinical response to the optimized therapy allowed a very satisfactory evolution in an 36-month follow-up, despite the very low maintenance of LVEF. The combination of resynchronization therapy + Sacubitril / Valsartan is an excellent alternative for patients with very low ejection fraction and limited functional class (III and IV).
Methods: Data collection was performed in heart failure clinic, and retrospective information was gathered at the electronic medical record.
Case: A 79-year-old man with dilated cardiomyopathy of ischemic etiology, hypertension, chronic kidney disease undergoing conservative treatment, history of stroke, was hospitalized due to HF decompensation, with hemodynamic profile B, NYHA III, 4 years ago. The patient had a history of frequent hospitalizations (3 in the last year). Echocardiogram revealed LVEF 10% (Teicholz) and 24% (Simpson) and myocardial scintigraphy with GATED 8%. There was no adequate response to drug therapy (Carvedilol, Enalapril, Furosemide and Digoxin) optimized, and cardiac resynchronization therapy was chosen. Five months after installing the device, the patient developed pneumonia, which resulted in further decompensation and hospitalization. We chose to start Sacubitril / Valsartan (24/26mg twice a day). Sequentially, there was a gain in functional class, reaching NYHA I, despite maintaining significant ventricular dysfunction [LVEF 20% (Simpson), 22% (Teicholz)]. There were no new admissions in the last 36 months, and the patient is still NYHA I.
Conclusion: Despite the association between LVEF and mortality, the functional class represents a more accurate risk marker than LVEF. In the case described, the excellent clinical response to the optimized therapy allowed a very satisfactory evolution in an 36-month follow-up, despite the very low maintenance of LVEF. The combination of resynchronization therapy + Sacubitril / Valsartan is an excellent alternative for patients with very low ejection fraction and limited functional class (III and IV).
Introduction: Heart failure with reduced ejection fraction (LVEF) has a high prevalence and high rates of mortality and morbidity.
Methods: Data collection was performed in heart failure clinic, and retrospective information was gathered at the electronic medical record.
Case: A 79-year-old man with dilated cardiomyopathy of ischemic etiology, hypertension, chronic kidney disease undergoing conservative treatment, history of stroke, was hospitalized due to HF decompensation, with hemodynamic profile B, NYHA III, 4 years ago. The patient had a history of frequent hospitalizations (3 in the last year). Echocardiogram revealed LVEF 10% (Teicholz) and 24% (Simpson) and myocardial scintigraphy with GATED 8%. There was no adequate response to drug therapy (Carvedilol, Enalapril, Furosemide and Digoxin) optimized, and cardiac resynchronization therapy was chosen. Five months after installing the device, the patient developed pneumonia, which resulted in further decompensation and hospitalization. We chose to start Sacubitril / Valsartan (24/26mg twice a day). Sequentially, there was a gain in functional class, reaching NYHA I, despite maintaining significant ventricular dysfunction [LVEF 20% (Simpson), 22% (Teicholz)]. There were no new admissions in the last 36 months, and the patient is still NYHA I.
Conclusion: Despite the association between LVEF and mortality, the functional class represents a more accurate risk marker than LVEF. In the case described, the excellent clinical response to the optimized therapy allowed a very satisfactory evolution in an 36-month follow-up, despite the very low maintenance of LVEF. The combination of resynchronization therapy + Sacubitril / Valsartan is an excellent alternative for patients with very low ejection fraction and limited functional class (III and IV).
Methods: Data collection was performed in heart failure clinic, and retrospective information was gathered at the electronic medical record.
Case: A 79-year-old man with dilated cardiomyopathy of ischemic etiology, hypertension, chronic kidney disease undergoing conservative treatment, history of stroke, was hospitalized due to HF decompensation, with hemodynamic profile B, NYHA III, 4 years ago. The patient had a history of frequent hospitalizations (3 in the last year). Echocardiogram revealed LVEF 10% (Teicholz) and 24% (Simpson) and myocardial scintigraphy with GATED 8%. There was no adequate response to drug therapy (Carvedilol, Enalapril, Furosemide and Digoxin) optimized, and cardiac resynchronization therapy was chosen. Five months after installing the device, the patient developed pneumonia, which resulted in further decompensation and hospitalization. We chose to start Sacubitril / Valsartan (24/26mg twice a day). Sequentially, there was a gain in functional class, reaching NYHA I, despite maintaining significant ventricular dysfunction [LVEF 20% (Simpson), 22% (Teicholz)]. There were no new admissions in the last 36 months, and the patient is still NYHA I.
Conclusion: Despite the association between LVEF and mortality, the functional class represents a more accurate risk marker than LVEF. In the case described, the excellent clinical response to the optimized therapy allowed a very satisfactory evolution in an 36-month follow-up, despite the very low maintenance of LVEF. The combination of resynchronization therapy + Sacubitril / Valsartan is an excellent alternative for patients with very low ejection fraction and limited functional class (III and IV).
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