Flinders University School of Medicine, Australia
Pupalan Iyngkaran is a Consultant Cardiologist and Senior Lecturer with subspecialty training in Heart Failure (CHF) and Cardiovascular Imaging with the Royal Darwin Hospital and Flinders University. He trained in cardiology at the Queen Elizabeth Hospital, South Australia and National Heart Centre, Singapore; with additional subspecialty training in echocardiography and HF research at the Flinders Medical Centre and Monash University. His research has involved basic science work on uremic toxins on cardiac myocytes, novel renal injury biomarkers, prospective databases, Indigenous patient journey mapping and translating regional specific disease management programs including self-care programs for CHF.
Congestive Heart Failure (CHF), a leading cause of morbidity and mortality in the Northern Territory (NT) and developed world, when confounded with concomitant renal insufficiency is associated with significant additional risk. The NT and remote Australia has a unique multiethnic demography, including a sizeable Indigenous population, spread over large geographical distances. Sixty percent live in 2 major towns serviced by 2 major public hospitals. Additional factors that can affect CHF management are prevalent in remote areas and are not well addressed within randomized controlled trials. The prevalence of renal insufficiency in CHF in the NT is significant. Accurate prospective data is lacking, however is likely greater than 40%. Co-morbid contributors and associations, in particular DM, HT, IHD, RHD, contribute further to the increased risks. Challenges continue to exist in accurately estimating the size of the problems, accurate diagnostics, disease prevention, and chronic disease management. This talk is focused on: firstly, exploring the size of the problem; secondly, exploring the available evidence from the major randomized CHF pharmaceutical trials; thirdly, a brief review of diagnostic renal injury and functional markers; and finally, exploring simple therapeutic options. The focus of these discussions has regional specific themes, however the broader themes may have universal appeal. A need to consider a wider therapeutic paradigm, from the standard guidelines is also discussed, as novel therapeutic options have been relatively slow to come by.
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