Comprehensive approach to managing heart Failure Patient
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Comprehensive Approach
to Managing HF patients
: Experience from Korea Seok-Min Kang, MD, Ph D.
(smkang@yuhs.ac)
Director, Heart Failure Center,
Professor, Division of Cardiology,
Severance Cardiovascular Hospital,
Yonsei University College of Medicine,
Seoul, Korea
Contents
• Prevalence of HF in Korea
• Current status of
- Device therapy (ICD, CRT, ECMO, LVAD) in HF
- Heart transplantation
- Cardiac Rehabilitation in HF
• Comprehensive and multidisciplinary team
approach in HF management
Increasing HF prevalence in Korea
(Data from National Health Insurance Service, Korea)
0
100
200
300
400
500
600
700
20032004200520062007200820092010201120122013
ICD
CRT
Number of ICD & CRT in Korea Cases
Year
Number of ECMO Cases in Korea
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2006 2007 2008 2009 2010 2011 2012
Cases
Year
Number of Heart Transplantation in Korea
1992-2014 : total 1,021 cases
12 21
11 15 23 26 29
50
84
65 73
98 107
127 118
0
20
40
60
80
100
120
1402000년
2001년
2002년
2003년
2004년
2005년
2006년
2007년
2008년
2009년
2010년
2011년
2012년
2013년
2014년
Cases
Year
Ready for LVAD in Severance
Comprehensive Management
Integrated Inter-
disciplinary Patient-centered
Transitions of Care in Heart Failure
Comprehensive HF management Program
Optimization
of
Drug Therapy
Intensive
Patient
Education
Vigilant f/u
and
Early recognition
of problem
Identification
and
Management
of comorbidities
Monthly HF-HR Joint Meeting
in Severance Cardiovascular Hospital
Heart Failure Team
Heart Rhythm Team
Monthly Heart Transplantation Committee
in Severance
Heart Failure Team
Cardiac Surgeon Team
: Severance Cardiac Wellness Center
(2011.7.4 Open)
(2012.7.4. 1st anniversary)
Cardiac Rehabilitation in Severance
Patients and Family Education
Evaluation and Reduction of CV risks
Physical Training, Psychosocial Counseling
Clinical Evaluation
Counseling on appropriate use of prescribed medications
• CR Nurse (n=2) • Clinical Exercise Specialist (n=1)
• Nurse practitioner (n=3)
Severance Cardiac Wellness Center
Symptom-limited CPET
• Assessment of symptom and
prognosis of HF patients
• Risk stratification
• Exercise prescription
심장재활 운동 프로그램
Exercise Training Program in HF
Item Study 1 month 2 month 3 month Follow up
Lower Extremity Muscle Power
Lower Extremity
Muscle - Quadriceps - Hamstring
Lower Extremity Muscle Power
Exercise (Leg press)
Low Intensity Interval
Reset exercise duration and intensity q
2 wks
Lower Extremity
Muscle - Quadriceps - Hamstring
Aerobic Exercise Capacity
Body Composition
(every 1 month) - Muscle - Body Fat - Visceral Fat
CPET - VO2peak - LT - HR, BP
Bicycle
Low Intensity Interval
Reset exercise duration and intensity q
2 wks
Body Composition (every 1 month)
- Muscle - Body Fat - Visceral Fat
CPET - VO2peak - LT - HR, BP
TMT
Walking
5~20 min
Walking slope 20~40 min
Reset walking slope q 2 wks
Enhanced External Counter
Pulsation (EECP) in Severance
Effect:
Systolic Unloading
Reduce Cardiac Workload
Increase Cardiac Output
Diastolic Augmentation
Increase Coronary Perfusion
Increase Cardiac Output
Effects:
Increase Venous Return
Hospitalization is the key moment
to optimize treatment
2013 ACCF/ AHA guidelines for HF
Recommendations for hospital discharge1
Nurse-led Follow-Up Program Schedule OPD F/U schedule, 30-50 minutes
Method HF Guidebook
Subjects HF patients and their families
Contents • Importance of medication adherence and regular follow up
• Self-Care
Aggravation of HF symptom monitoring
Monitoring BW everyday
Restricted sodium diet
Non-smoking, Alcohol Moderation
• Flu vaccination periodically
• Comorbidity management
• Emotional support
• Telephone counseling
P = 0.010
Patients in usual care (n=98)
(After adjusting age, gender, etiology of HF, BMI, comorbidities, LVEF, use of RAS blockers, beta blockers, and digoxin)
P = 0.014 Patients in usual care (n=98)
(After adjusting age, gender, etiology of HF, BMI, comorbidities, LVEF, use of RAS blockers, beta blockers, and digoxin)
C Rhou, SM Kang, et al. 2012 AHA abstract
Heart Failure Clinic
Diet Education in HF
Sodium Intake in Korea
Source : Korea Food and Drug Administration 2010
Daily sodium
Intake (grams)
South Korea
Japan
UK
USA
Recommended
Allowance
by WHO
4.878
4.28
3.44
3.436
2
Annual Low Salt Cooking Class
CVD(in-patients) HF (out-patients)
HF Clinic Cardiac Wellness Center
• Pre-discharge education for performance measure
• Heart Rhythm Team
• Heart Failure Team
• Cardiac Imaging Team
• Heart Failure Team
• Cardiac Surgeon Team
• Pathology Team
Improve Clinical Outcomes
Nurse-led Follow-Up Program Cardiac Rehabilitation Program
Multidisciplinary Team Approach in HF Management
HF specialists (MD)
CR co
ord
inato
rs (N
urse
) D
ietitians
Certificated Clinical Exercise Specialist
HR specialists (MD)
Cardiac surgeons (MD)
Cardiac Imaging Specialists (MD)
Pediatrician (MD)
LifeTag Service in Emergency Situation
Korean Society of Heart Failure
(www.khfs.or.kr)
Appreciate your attention
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