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Review article: Biomedical intelligence

Vol. 140 No. 2930 (2010)

Novelties in the early management of acute heart failure syndromes

  • R Salem
  • F Sibellas
  • T Socrates
  • N Arenja
  • A Mebazaa
  • MB Yilmaz
DOI
https://doi.org/10.4414/smw.2010.13031
Cite this as:
Swiss Med Wkly. 2010;140:w13031
Published
19.07.2010

Summary

The recent European Society of Cardiology (ESC) guidelines delineate the diagnosis and management of distinct categories of acute heart failure syndromes. However, physicians dealing with these patients may need guidance in choosing therapeutic alternatives as soon as the dyspneic patient arrives at the emergency department, until distinct categories of the ESC guidelines are identified. Hence, this manuscript summarizes practical recommendations for the very early management of patients with acute heart failure syndromes. The recommendations are based on a clinical classification system considering the initial systolic blood pressure and other symptoms. Early initiation of diagnostic and goal-directed treatment strategies are key factors in improving patient outcomes. Early and frequent reassessment is also imperative so that adjustments to the initial therapeutic approach can be made, as clinically indicated.

References

  1. Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112:3958–68.
  2. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29:2388–442.
  3. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation J Am Coll Cardiol. 2009;53:e1-e90.
  4. Mebazaa A, Gheorghiade M, Piña IL, Harjola VP, Hollenberg SM, Follath F, et al. Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med. 2008;36(1 Suppl):S129–39.
  5. Emerman CL. Treatment of the acute decompensation of heart failure: efficacy and pharmacoeconomics of early initiation of therapy in the emergency department. Rev Cardiovasc Med. 2003;4(Suppl 7):S13–S20.
  6. Nohria A, Tsang SW, Fang JC, Lewis EF, Jarcho JA, Mudge GH, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41(10):1797–804.
  7. Siebert U, Januzzi JL Jr, Beinfeld MT, Cameron R, Gazelle GS. Cost-effectiveness of using N-terminal pro-brain natriuretic peptide to guide the diagnostic assessment and management of dyspneic patients in the emergency department. Am J Cardiol. 2006;98(6):800–5.
  8. Maisel A, Mueller C, Adams K Jr, Anker SD, Aspromonte N, Cleland JG, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008;10:824–39.
  9. Passino C, Poletti R, Fontana M, Vergaro G, Prontera C, Gabutti A, et al. Clinical relevance of non-cardiac determinants of natriuretic peptide levels. Clin Chem Lab Med. 2008;46(11):1515–23.
  10. Tarantini L, Cioffi G, Gonzini L, Oliva F, Lucci D, Di Tano G, et al., on behalf of the Italian Acute Heart Failure Survey. Evolution of renal function during and after an episode of cardiac decompensation: results from the Italian survey on acute heart failure. J Cardiovasc Med. (Hagerstown). 2009 Oct 23. [Epub ahead of print]
  11. Damman K, Jaarsma T, Voors AA, Navis G, Hillege HL, van Veldhuisen DJ; COACH investigators. Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH). Eur J Heart Fail. 2009;11(9):847–54.
  12. Ilva T, Lassus J, Siirilä-Waris K, Melin J, Peuhkurinen K, Pulkki K, et al. Clinical significance of cardiac troponins I and T in acute heart failure. Eur J Heart Fail. 2008;10(8):772–9.
  13. Zannad F, Mebazaa A, Juillière Y, Cohen-Solal A, Guize L, Alla F, et al.; EFICA Investigators. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail. 2006;8(7):697–705.
  14. Dahle TG, Sobotka PA, Boyle AJ. A practical guide for ultrafiltration in acute decompensated heart failure. Congest Heart Fail. 2008;14(2):83–8.
  15. Breidthardt T, Noveanu M, Potocki M, Reichlin T, Egli P, Hartwiger S, et al. Impact of a high-dose nitrate strategy on cardiac stress in acute heart failure: a pilot study. J Intern Med. 2009 Jun 22. [Epub ahead of print]
  16. Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J; 3CPO Trialists Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. 2008;359(2):142–51.
  17. Masip J, Mebazaa A, Filippatos GS. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. 2008;359:2068–9.
  18. Mebazaa A, Nieminen MS, Filippatos GS, Cleland JG, Salon JE, Thakkar R, et al. Levosimendan vs. dobutamine: outcomes for acute heart failure patients on {beta}-blockers in SURVIVE. Eur J Heart Fail. 2009;11:304–11.
  19. Mebazaa A, Pitsis AA, Rudiger A, Toller W, Longrois D, Ricksten SE, et al. Practical Recommendations on the Management of Perioperative Heart Failure in Cardiac Surgery. Crit Care, Article in press.
  20. Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LS, van Domburg RT, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30(17):2102–8.
  21. Jondeau G, Neuder Y, Eicher JC, Jourdain P, Fauveau E, Galinier M, et al.; B-CONVINCED Investigators. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186–92.