CPU Writing GroupuDr. Lisa Mielniczuk(Theme Lead)uDr. Michael McDonald uDr. Liz SwiggumuDr. Justin EzekowitzuDr. Anique Ducharme

DisclosuresConsulting/Advisory Board: Abbott, Akcea, Astra Zeneca, Amgen, Alnylam, Boehringer Ingelheim, CardiolTherapeutics, Merck, Novartis, Pfizer, ServierSpeaker: Astra Zeneca, Boehringer Ingelheim, Eli-Lilly, Novartis, ServierClinical Trials:Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Merck, Novartis Research Grants:NovartisEducational Grants:Servier CCS CHFS Clinical Practice Update HF Phenotype Pathway PreviewShelley Zieroth, MDPresident, Canadian Heart Failure Society CPU Writing GroupuDr. Lisa Mielniczuk(Theme Lead)uDr. Michael McDonald uDr. Liz SwiggumuDr. Justin EzekowitzuDr. Anique Ducharme uDr. Shelley Zieroth (Theme Lead)uDr. Jonathan HowlettuDr. John MacFadyenuDr. Serge LepageuDr. VineetaAhoojauDr. Stephanie PoonuDr. Eileen O’MearauDerek Leong RPhuDr. Kim Anderson ObjectivesuPreview/crowdsourcethe CHFS phenotype pathway/algorithm for the practical application of HF therapies uReveal the CHFS inpatient HF order set, discharge tool and patient diary NOTE: Final CCS CHFS CPU HF Phenotype Pathway will be e-published in the Canadian Journal of Cardiology simultaneous with the CHFS Spotlight podium presentation at the Canadian Cardiovascular Congress, October 22-25, 2020 Clinical Course of Heart Failure 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized WithHeartFailure Steven M. Hollenberg, Lynne Warner Stevenson, Tariq Ahmad, Vaibhav J. Amin, BiykemBozkurt, JavedButler, Leslie L. Davis, Mark H. Drazner, James N. Kirkpatrick, Pamela N. Peterson, Brent N. Reed, Christopher L. Roy, Alan B. Storrow, J Am Coll Cardiol. 2019 Oct, 74 (15) 1966-2011 Phenotypes T2DM CRS/Stalled Wet Hypertensive Elderly Afib High Heart Rate LBBB HFpEFHFmrEF De novo Type 2 DiabetesuIn a patient with Type 2 DM and LVEF 35% and NYHA 2-3 symptoms how would you prioritize their GDMT (assuming Health Canada/ regulatory approval)A) RASiBB MRA SGLT2iB) RASiSGLT2i BB MRAC) SGLT2i RASiBB MRA RASi= (Ace or ARB or ARNi)BB = (B Blocker)MRA = (Mineralocorticoid receptor antagonist)SGLT2i = (Sodium glucose co-transporter 2 inhibitors) Type 2 DiabetesuIn a patient with Type 2 DM and LVEF 35% and NYHA 2-3 symptoms how would you prioritize their GDMT (assuming Health Canada/ regulatory approval)What did the majority around the CPU table say? A) RASiBB MRA SGLT2iB) RASiSGLT2i BB MRAC) SGLT2i RASiBB MRA How About Without Type 2 Diabetes ?uIn a patient with LVEF 35% and NYHA 2-3 symptoms how would you prioritize their GDMT (assuming Health Canada/ regulatory approval)A) RASiBB MRA SGLT2iB) RASiSGLT2i BB MRAC) SGLT2i RASiBB MRA RASi= (Ace or ARB or ARNi)BB = (B Blocker)MRA = (Mineralocorticoid receptor antagonist)SGLT2i = (Sodium glucose co-transporter 2 inhibitors) How About Without Type 2 Diabetes ?uIn a patient with LVEF 35% and NYHA 2-3 symptoms how would you prioritize their GDMT (assuming Health Canada/ regulatory approval)uWhat did the majority around the CPU table say?A) RASiBB MRA SGLT2iB) RASiSGLT2i BB MRAC) SGLT2i RASiBB MRA How About Without Type 2 Diabetes ?uIn a patient with LVEF 35% and NYHA 2-3 symptoms how would you prioritize their GDMT (assuming Health Canada/ regulatory approval)uIn the last case which 2 drugs would you start simultaneously?A) RASiBB MRA SGLT2iB) RASiSGLT2i BB MRAC) SGLT2i RASiBB MRAD) SGLT2i RASiBB MRA High Heart RateuIn a euvolemic patient with a BP of 90/60 on metoprolol 100 mg po BID and a Heart Rate of 98 bpm (sinus) LVEF 35% and NYHA 2-3 symptoms how would you address the residual risk of elevated heart rate?A) UptitrateBblockerB) Add ivabradine High Heart RateuIn a euvolemic patient with a BP of 90/60 on metoprolol 100 mg po BID and a Heart Rate of 98 bpm (sinus) LVEF 35% and NYHA 2-3 symptoms how would you address the residual risk of elevated heart rate?uWhat did the majority around the CPU table say?A) UptitrateBblockerB) Add ivabradine De novo HFrEFuIn a patient admitted with newly diagnosed ADHF with LVEF 35% how would you prioritize their in hospital GDMT (assuming NOregulatory restriction) ? A) ACEiBB MRA then switch to ARNI as outpatientB) ACEiBB MRA no switch to ARNI as outpatient until reassess LVEFC) ARNI BB MRA ACEi= Ace InhibitorBB = Beta blockerMRA = Mineralcorticoidreceptor antagonisARNI = Angiotensin receptor neprilysininhibitor De novo HFrEF uIn a patient admitted with newly diagnosed ADHF with LVEF 35% how would you prioritize their in hospital GDMT (assuming NOregulatory restriction) ? uWhat did the majority around the CPU table say? A) ACEiBB MRA then switch to ARNI as outpatientB) ACEiBB MRA no switch to ARNI as outpatient until reassess LVEFC) ARNI BB MRA 50% already use ARNI 1stline 17 Heartfailure.caInsuffisancecardiaque.ca