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Healthcare in the Age of Disruption

Raj Khandwalla MD MA FACC Raj.khandwalla@cshs.org

@rajkmd

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6 Accelerating Computing Power

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80% of what physicians do might be replaced in the future

Vinod Khosla, Founder Sun Microsystem

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17 Baumol’s Cost Disease

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19 AWAKE-HF Does sacubtril/valsartan (Entresto) increase activity and improve sleep in patients with systolic heart failure?

Baseline Secondary endpoint

Secondary endpoint

Secondary endpoint

Primary endpoint

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21 AWAKE-HF OUTSTEP-HF Objectives Determine:

• Effect of initiation of sacubitril/valsartan treatment versus enalapril on physical activity during the waking hours

• Effect of initiation of sacubitril/valsartan treatment versus enalapril on subjects’ sleep

Demonstrate the superiority of sacubitril/valsartan over enalapril in increasing non-sedentary physical activity in HFrEF patients

Duration • 2 weeks current HF therapy • 8 weeks sacubitril/valsartan or enalapril • 8 weeks sacubitril/valsartan

• 2 weeks current HF therapy • 12 weeks sacubitril/valsartan or enalapril

Patients, n 136 600

Patient population

Outpatient male and female subjects, between 18 - 80 years of age, with HFrEF NYHA class II or III

18 Years and older male and female subjects, chronic symptomatic HF (NYHA class ≥ II) with reduced ejection fraction, defined as known LVEF ≤ 40% AND one of the following two criteria: • Plasma NT-proBNP level of ≥ 300 pg/mL or BNP ≥ 100

pg/mL (measurement may be recorded no longer than past 12 months) OR

• Confirmation of a heart failure hospitalization last 12 months.

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Combining AWAKE & OUTSTEP Data

Can actigraphy data predict

• Clinical events such as HF hospitalizations?

• Quality of life scores (KCCQ)?

• Left ventricular ejection fraction?

• Naturietic peptide levels?

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Major Problem: Most Days of Heart Failure Management Are Not Clinic or Hospital Days

HF Clinic Device Clinic

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