Day 1 :
Prevail Heart Clinics, USA
Keynote: Utilizing Computer Assisted Medication Management to Improve Outpatient Treatment of Heart Failure and Reduce Heart Failure Hospitalizations
Time : 10:00-10:40
Kevin A. Courville, is a Fellow of the Heart Failure Society of America, Fellow of the American College of Cardiology and Alpha Omega Alpha Honor Medical Society. He received his cardiology training at Ochsner Heart and Vascular Institute in New Orleans, Louisiana. He has been recognized as one of the top cardiologists in America for several years and dedicates his clinical, research and development efforts into the outpatient management of heart failure and chronic cardiovascular diseases.
Optimal outpatient management of patients with chronic heart failure requires implementation and execution of evidence-based therapies, careful monitoring of clinical status, adequate patient education, adherence to patient's self-directed goals and readily available access to knowledgeable healthcare providers and/or heart failure specialists. These initiatives have the burden of a significant time and resource requirement. The ratio of the exponential increase in the number of patients with heart failure versus specialty heart failure providers are forcing patients to receive care from providers who do not have a primary focus on the treatment of heart failure nor the time or resources to "keep up" with all aspects of care required of each patient. PULSARIO Remote Heart Management system integrates these objectives with provider education and computer assisted medication titration into a single unified solution which enables the non-heart failure specialists to treat heart failure patients to the level of specialty care. Prevail Heart Clinics (PHC) evaluated 394 consecutive patients from October 2014 thru May of 2016. Patients were enrolled into the Prevail solution using the Pulsario system and treated as per goals directed by the Pulsario system and the Prevail team. The result was an all-cause 30-day readmission rate of only 6.1% and a 71.4% reduction of HF hospitalizations during the first year of application of this technology into a rural clinic with predominant care provided by a physician assistant. Computer assisted medication management in the Pulsario system is feasible, cost effective, clinically effective and improves the lives of patients with heart failure.
Institute of Cardiac and Diagnostic Therapy, Germany
Time : 10:40-11:30
Heinz-Peter Schultheiss, Professor of Internal Medicine and Cardiology, is CEO of Institute for cardiac diagnostic and therapy (IKDT) Berlin, Germany since 2003. He was the chairman of the Working group “Inflammatory heart muscle diseases“ of the German Society of Cardiology, Chairman of the “Working Group on Myocardial and Pericardial Disease“ of the European Society of Cardiology, Member of the "Council on Cardiomyopathies“ of the International Society of Cardiology, Chairman of the Medical Society Berlin, Member of German Society for Internal Medicine, Member of European Society of Cardiology
Cardiomyocytes can be destroyed by direct virus damage, the antiviral immune response, or a truly autoimmune injury. Beside an optimal heart failure therapy, the mainstay of treatment for myocarditis and inflammatory cardiomyopathy (CMi) is the biopsy-proven specific immunomodulatory treatment regarding the underlying pathophysiological mechanisms. Chronic viral infections of the heart (mainly Parvovirus B19, Human-Herpes virus (HHV) 6, Coxsackie-adeno virus, Ebstein-Barr virus, Cytomegalie virus, and Hepatitis virus) are considered one antecedent event leading to progressive dysfunction of the myocardium, often with an impaired prognosis due to a virus- or immune-mediated myocardial injury.
The effectiveness of anti-viral-therapy has been proven in recent studies, showing that enterovirus/ adenovirus – positive patients benefit from anti-viral therapy with interferon beta-1b, whereas in patients suffering from parvovirus B19 infection no established therapy exists. However, the nucleoside analogues Telbivudine seems to be a promising drug in patients with proof of active viral replication. Follow-up studies revealed an association with HHV6 and the clinical course of myocarditis and CMi. HHV-6 is able to integrate its genomes into telomeres of human chromosomes. We recently demonstrated that antiviral therapy with Ganciclovir can diminish HHV-6 replication as well as cardiac symptoms of these patients. Myocardial inflammatory processes due to autoimmunity warrant immunosuppressive treatment in order to prevent immune-mediated myocardial injury. Immunosuppression (treatment with prednisone and azathioprine for 6 months) demands biopsy-based exclusion of virus since virus-positive patients do not improve or even deteriorate under anti-inflammatory treatment, while virus-negative patients with post-infectious, auto-immune inflammatory process respond well in clinical trials, and - after termination - long lasting LVEF improvement has been documented.
Federal University of RN, Brazil
Time : 11:50-12:30
Waldo Emerson Pinheiro Daniel has completed the graduation of Medicine in the Federal University of Rio Grande do Norte (UFRN) on August 18, 1992; at the age of 25 years old. Concluded Medical Residence in General Surgery in 12/31/1994 by Federal University of Rio Grande do Norte, Onofre Lopes Hospital, being awarded the title of specialist. In 01/02/1995 started the Medical Residency in Cardivascular Surgery at São Joaquim Hospital of the Real and Benemérita Portuguese Society of Beneficence of São Paulo, Dr. José Pedro da Silva service, where remained until 12/12/1998, when concluded and being awarded the title of specialist. He is Associated Member of Brasilian Society of Cardiovascular Surgery. When he came back to Natal/RN has assembled a team, dedicating the Adult Cardiac Surgery, But mainly MICS and Aortic Surgery and he has been working in several private Hospital and the University Hospital of which he is the Head of the Cardiovascular Surgery Service at the moment.
The present study was performed with 132 patients with Coronary Artery disease, randomly selected, excluding only those with a greatly increase Cardiac area and/ or patient with ejection fraction below 40%, as well as patients with severe pneumopahies and significant depression of ventilatory function. All patients underwent complete revascularization of the myocardium without the use of extracorporeal circulation, nor at least as ventricular assistance and the access was performed through left anterolateral thoracotomy. The left Internal Mamary artery was harvested in its entirety and by direct vision in used in situ; the Safenous Graft, when used, its proximal anastomosis is performed first and in the ascending portion of the Aorta Artery. In the first and a few days after surgery, it was observed there was a significant decreases in thoracic drainage volume(competed to conventional surgery), past the first postoperative day, the analgesia is decreased and usually the patients leaves the CTI. These patients invariably present as oligossymptomatic or even asymptomatic, more confident, being discharged about the 4th day of hospitalization. After discharge, in consultation, the patients reported us, the early return to their normal life and their satisfaction with it, consequently whit the procedure. After six months, the same patients underwent coronary Angiotomography(That show us a hundred per cent of Mamary Artery graft and eight nine per cent of the safenous graft pattency), to control graft patency and also the clinical evaluation, that in this series, precisely in this is month evaluation, no patient presented any complaints or symptoms.