Course:PHAR451/CHF

Heart Failure Therapeutics
PHAR 451
Section:
Instructor:	Dr. Peter Loewen
Email:	peter.loewen@ubc.ca
Office:	PHRM 6624
Office Hours:
Class Schedule:	Monday, November 23, 2015
Classroom:	PHRM 1101
Important Course Pages
	Syllabus
	Lecture Notes
	Assignments
	Course Discussion

Heart Failure Therapeutics

updated November 2015

Pre-Session Objectives

PRIOR TO arriving at the session, participants should be able to name the CHF-applicable drugs, usual dose ranges, and common toxicities of all the following classes/drugs:

• diuretics
• ACE inhibitors
• ARBs
• B-Blockers
• spironolactone / eplerenone
• digoxin

Preparation for the session

1. EXPERIMENT with the Seattle Heart Failure Model to appreciate the survival rates, and what factors affect survival positively and negatively in patient with heart failure.
2. INSTALL the iCCS app on your handheld patient care device.
3. READ The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice. The Canadian Journal of Cardiology 2015;:1–15.
4. REVIEW the SESSION MATERIALS (below) and come prepared to ask questions about the therapeutics as we review it together
5. EXAMINE the diagram below to appreciate the overall approach to CHF therapeutics:

By the end of the session, and upon study and reflection, students should be able to

1. identify drug related-causes of heart failure

2. describe the role, dosing, and monitoring parameters (efficacy and toxicity) of the following drugs in the treatment of HF:

• diuretics
• ACE inhibitors
• ARBs
• B-Blockers
• spironolactone / eplerenone
• digoxin

3. given a case of a patient with heart failure, determine an appropriate drug treatment regimen including monitoring parameters (efficacy and toxicity).

4. given a case of a HF patient on a given drug regimen, modify the regimen to resolve actual and potential drug-related problems, and list monitoring parameters (efficacy and toxicity)

Session Materials

• Session slides (Color)
• Session slides (B&W)
• Cases for discussion
• CASE NOTES

Supportive Literature & Further Reading

1. CCS Heart Failure Pocket Guide 2015
2. The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice.
3. Canadian Heart Failure Network
4. 2013 ACCF/AHA Guideline for the Management of Heart Failure
5. Canadian Cardiovascular Society 2012 Heart Failure guideline update
6. PARADIGM-HF
7. Q-SYMBIO
8. Heart Failure CME Review
9. Med-HF iOS app
10. Seattle Heart Failure Model
11. NSAIDs and heart failure: Arch Intern Med 2000;160:777-84, Arch Intern Med 1998;158:1108-12, Lancet 2004;363:1751-6
12. Glitazones & heart failure: JAMA 2007;298:1189-95, JAMA 2007;298:1180-8
13. WARCEF
14. CCS 2006 CHF Guidelines. Can J Cardiol 2006;22:23-45; UPDATE: Can J Cardiol 2009;25(2):85-105; UPDATE: Can J Cardiol 2011;27:319-338.
15. Overall effects of ACE-I in CHF: Lancet 2000; 355:1575–81
16. BC Heart Failure Guidelines
17. Overall effects of B-Blockers in CHF: Ann Intern Med. 2001;134:550-560
18. Start with B-blocker or ACE-I? CIBIS III
19. COMET. Lancet 2003; 362: 7–13
20. Furosemide self-management: action plan; does self-management improve outcomes? HART. JAMA 2010;304:1331-1338
21. RALES. N Engl J Med 1999:341:709-17.
22. EPHESUS. N Engl J Med 2003;348:1309-21
23. EMPHASIS-HF. N Engl J Med 2010. 10.1056/NEJMoa1009492
24. VALIANT. N Engl J Med 2003;349:1893-906.
25. CHARM-Alternative. Lancet 2003; 362:772–6; CHARM-Added. Lancet 2003; 362:767–71
26. Does ARB dose matter? HEAAL. Lancet 2009;
27. DIG Trial. N Engl J Med 1997;336:525-33
28. BNP-guided therapy: Arch Intern Med. 2010;170(6):507-514
29. Statins: CORONA. NEJM 2007;357:Nov6; GISSI-HF.Lancet 2008;372;1231-9
30. HOOPS: Eur Heart J. doi:10.1093/eurheartj/ehr433. 17NOV11
31. Pharmacist Intervention to Improve Medication Adherence in Heart Failure. Ann Intern Med. 2007;146:714-725.