Haider Warraich
speaker
683 appearances
3 recordings
1 series
first heard Oct 2020
last heard Dec 2021
Haider Warraich’s voice in public audio — every appearance, attributed to the second.
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Appearances
So they have very, very low appetite.
So even though it may look like their weight is going up, but their muscle mass is going down.
When I start seeing that, I am very worried about a patient.
So I always ask about appetite.
I always get a sense for what their mental status is like because a lot of time confusion, cognitive dysfunction can be a common presentation for patients who are approaching sort of more end stage like heart failure.
And then obviously, if you're running into situations where a patient may need, we're thinking of things like inotropes, et cetera, that's definitely a big red flag.
So those are some of the things, just to reiterate, recurrent hospitalizations, worsening end-organ dysfunction, cardiac cachexia, essentially malnutrition, anorexia, needing inotropes.
Those are some of the sort of, and inability to tolerate heart failure therapies because of low blood pressure.
these are some of the big things.
When I start seeing those, I start to become concerned about a patient.
In fact, if you look at a population-wide level, heart failure mortality is actually starting to creep up over the last recent years, which is very different from ischemic heart disease, which is still seeing continuous reductions.
And just another nice tidbit for listeners.
So if you have a patient who's older than 65, so what I'm quoting is from a study that was done of Medicare patients only.
and you have a patient who's been hospitalized for heart failure, so not recurrent hospitalization, it's any older patient with heart failure in the hospital, their median survival is 2.1 years.
So again, if you're older, that's going to be lower.
And if you're in the lower spectrum of the 65 and beyond group, it's going to be longer.
But that's a good number, at least in my mind, as an average.
And in this group, and these are data from the AHA's Get to the Guidelines heart failure registry.
And in this group, whether you had low EF or whether you had normal EF, no difference in survival.
So one sort of key number that I keep in my mind when I speak to, when I'm teaching residents or interns is to have this sort of 2.1 year number in mind when you have an older heart failure patient.
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