1 / 21

erland.erdmann@uni-koeln.de

Was gab es Neues bei der AHA zur Herzinsuffizienz?. Der Konsiliararzt Der Kardiologe Der Internist Der Allgemeinarzt. erland.erdmann@uni-koeln.de. The Cardiac Arrhythmia Suppression Trial. n = 1498, VES after MI, Encainide, flecainide, moricizine

carlo
Download Presentation

erland.erdmann@uni-koeln.de

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Was gab es Neues bei der AHA zur Herzinsuffizienz? • Der Konsiliararzt • Der Kardiologe • Der Internist • Der Allgemeinarzt erland.erdmann@uni-koeln.de

  2. The Cardiac Arrhythmia Suppression Trial n = 1498, VES after MI, Encainide, flecainide, moricizine Die Rhythmusstörungen verschwanden, aber… “There was an excess of deaths due to arrhythmia and deaths due to shock after acute recurrent MI in patients treated with encainide or flecainide.“ Echt et al., NEJM 1991; 324: 781

  3. „Der Kardiologe als Consiliarius“ 1. Impact of transfusion on postoperative MI or death (FOCUS TRIAL) Blutkonserven bei Hb < 10 oder bei Symptomen 2016 Pat. nach TEP, 82 Jahre Ergebnis: kein Unterschied (Tod, MI, Angina) bis auf mehr Schlaganfälle und mehr TVT

  4. „Chirurgische Studien“ 2. Outcomes of patients with advanced HF treated with either a pulsatile or continous flow LVAD (HEARTMATE II Destination Therapy Trial) Ergebnis: Countinous flow device sehr viel besser, (nach 2 Jahren leben noch 58 vs. 24 %)

  5. Advanced Heart Failure Treated withContinuous-Flow Left Ventricular Assist Device

  6. Vergleich der REMATCH- und der aktuellen Studie 1. Rose et al., N Engl J Med 2001;345:1435-43.

  7. „Chirurgische Studien“ 3. Influence of baseline global and regional cardiac function on outcome of patients randomised to CABG with or without surgical ventricular reconstruction Ergebnis: kein Unterschied, auch nicht in irgendeiner Subgruppe

  8. „Kardiologische Studien“ 4. Comparison of low-dose versus high-dose Losartan treatment on morbidity and mortality in ACE-I-intolerant patients with heart failure and reduced LVEF (<40%)(HEAAL-Study) 50/150 mg, Ergebnis: bessere Wirkung aber auch mehr NW: Renal impairment (n=454 vs 317), hypotension (203 vs 145), and hyperkalaemia (195 vs 131)

  9. www.the lancet.com Published online November 17, 2009 DOI:10.1016/S0140-6736(09)61913-9

  10. Eff ects of high-dose versus low-dose losartan on clinicaloutcomes in patients with heart failure (HEAAL study):a randomised, double-blind trial Death or admission for HF

  11. „Medikamenten-Studien“ 5. Ferric carboxymaltose assessment in patients with iron deficiency and chronic HF with and without anemia (FAIR-HF) Ergebnis: Sowohl bei Pat. mit als auch ohne Anaemie deutliche Besserung des Befindens

  12. N = 459, 67 years, MI 57 %, NYHA III, EF < 40%, (ferritin level <100 μg per liter or between 100 and 299 μg per liter, if the transferrin saturation was <20%), and a hemoglobin level of 9.5 to 13.5 g per 100 ml, Results were similar in patients with anemia and those without anemia!

  13. A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease Hemoglobin Levels among Patients With Darbepoetin Alfa or Placebo. Age: 68 A1c: 7,0, Crea: 1,8 HF : 33% KHK: 44% MI : 18% Pfeffer M et al. N Engl J Med 2009;361:2019-2032

  14. Kaplan-Meier Estimates of the Probability of the Primary and Secondary End Points Pfeffer M et al. N Engl J Med 2009;361:2019-2032 Adverse events: stroke: 101 vs.53, death: 412 vs.395, VTE: 41 vs. 23, ATE: 178 vs 144

  15. 77 years, NYHA III, EF 30%, Crea 1,33, BNP ~4000 Conclusion: Heart failure therapy guided by N-terminal BNP did not improve overall clinical outcomes or quality of life compared with symptom-guided treatment. Pfisterer et al., JAMA. 2009;301:383-392

  16. Zusammenfassung • pathophysiologisches Denken in der Medizin kann allenfalls dazu dienen, neue Hypothesen zu formulieren • Die Bedeutung einer Klinischen Studie kann nicht überschätzt werden • Wir müssen outcome-Studien fordern, bevor wir Therapieprinzipien ändern/akzeptieren • Surrogatparameter können uns fehlleiten!

More Related