如何避免慢性心力衰竭恶化.pptVIP

Chronic Heart Failure and Disease Burden Cost-effectiveness of BNP gTx * * * * * * Tohru Izumi, Toshimi Koitabashi, Mototsugu Nishii, Takayuki Inomata Department of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara 288-8555, Japan Oct 23rd, 2008, Beijing, How to Prevent From Worsening of Chronic Heart Failure The 4 th China-Japan Cardiovascular Forum (CJCF) Burden Aging CV Event CV Event BNP guided therapy for CHF patient Reduction of cardiac event (disease burden) Indicator: BNP CHF ACEI+BB Tx Comprehensive management Diuretics ０　　　　１８　　　 ４０　　　１００　　 ２００　　５００　pg/mL　 ＢＮＰ scale * Plasma BNP level is titrated by RIA using Shionoria (Shionogi, Osaka) After discharge with/without BNP guided Follow up period after discharge (days) 1.0 0.6 0.8 0 0.2 0.4 0 200 400 600 Cardiac-event -free survival Clinical guided Tx BNP guided Tx p=0.0435 readmission rate 365 days 16.6% 31.5% ?In two years follow-up, there were significantly lower cardiac events, readmission, in BNP guided Tx in comparison with the clinical guided Tx. Cumulative rate of the event within one year reduced from 31.5 to 16.6%. Inomata T, et al. Jpn Circ J 2001;65 (S-1A), 282. Group I Group II SR SR Af Af Koitabashi T, Inomata T, et al. ESC 2004 BNP guided Tx cancelled out prognostic contribution by AF in CHF management Altered prognosis of Af Pts by introducing BNP guided Tx HF-event-free survival(%) Group II BNP guided era(‘00-02) Group I Clin guided era (‘96-98) SR group Af group Follow-up period(month) 200pg/mL ≥200pg/mL Event free survival 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 0 10 20 30 40 50 60 70 80 90 Follow-up period (months) Event free survival 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 0 10 20 30 40 50 60 70 80 90 Follow-up period (months) P0.0001 Total death Arrhythmic events BNP100pg/ml, n=213 BNP≧100pg/ml, n=176 P=0.0028 BNP100pg/ml, n=213 BNP≧100pg/ml, n=176 BNP and Arrhythmic Prognosis KITASATO UNIVERSITY QALY (quality adjusted life year) Years Costs ＄ ＊ ＊ ＊ Mo