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Pre-discharge and early post-discharge management of patients hospitalized for acute heart failure: A scientific statement by the Heart Failure Association of the ESC |
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| Authors: | Marco Metra Marianna Adamo Daniela Tomasoni Alexandre Mebazaa Antoni Bayes-Genis Magdy Abdelhamid Stamatis Adamopoulos Stefan D. Anker Johann Bauersachs Yuri Belenkov Michael Böhm Tuvia Ben Gal Javed Butler Alain Cohen-Solal Gerasimos Filippatos Finn Gustafsson Loreena Hill Tiny Jaarsma Ewa A. Jankowska Mitja Lainscak Yuri Lopatin Lars H. Lund Theresa McDonagh Davor Milicic Brenda Moura Wilfried Mullens Massimo Piepoli Marija Polovina Piotr Ponikowski Amina Rakisheva Arsen Ristic Gianluigi Savarese Petar Seferovic Rajan Sharma Thomas Thum Carlo G. Tocchetti Sophie Van Linthout Cristiana Vitale Stephan Von Haehling Maurizio Volterrani Andrew J.S. Coats Ovidiu Chioncel Giuseppe Rosano |
| Affiliation: | 1. Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy;2. AP-HP Department of Anesthesia and Critical Care, Hôpital Lariboisière, Université Paris Cité, Inserm MASCOT, Paris, France;3. Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Badalona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain CIBERCV, Instituto de Salud Carlos III, Madrid, Spain;4. Faculty of Medicine, Cairo University, Giza, Egypt;5. Second Department of Cardiovascular Medicine, Onassis Cardiac Surgery Center, Athens, Greece;6. Department of Cardiology (CVK);7. and Berlin Institute of Health Center for Regenerative Therapies (BCRT);8. German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany;9. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany;10. Lomonosv Moscow State University, Moscow, Russia;11. Saarland University Hospital, Homburg/Saar, Germany;12. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;13. Baylor Scott and White Research Institute, Dallas, TX, USA Department of Medicine, University of Mississippi, Jackson, MS, USA;14. Inserm 942 MASCOT, Université de Paris, AP-HP, Hopital Lariboisière, Paris, France;15. Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece;16. Rigshospitalet-Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark;17. Queen's University Belfast, Belfast, UK;18. Linkoping University, Linkoping, Sweden;19. Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland;20. Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia;21. Volgograd State Medical University, Volgograd, Russia;22. Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden;23. Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK;24. Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA;25. Faculty of Medicine, University of Porto, Porto, Portugal Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal;26. Hospital Oost-Limburg, Genk, Belgium;27. Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy Department of Biomedical Science for Health, University of Milan, Milan, Italy;28. Faculty of Medicine, University of Belgrade, Belgrade, Serbia;29. Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan;30. School of Medicine, University of Belgrade, Belgrade, Serbia;31. Faculty of Medicine, University of Belgrade, Belgrade, Serbia Serbian Academy of Sciences and Arts, Belgrade, Serbia;32. St. George's Hospitals NHS Trust University of London, London, UK;33. Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies, Hannover Medical School, Hannover, Germany Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany;34. Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy;35. German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité-Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany;36. Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy;37. Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany German Center for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany;38. University of Warwick Coventry, Coventry, UK;39. Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, University of Medicine Carol Davila, Bucharest, Romania;40. St. George's Hospitals NHS Trust University of London, London, UK Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy |
| Abstract: | Acute heart failure is a major cause of urgent hospitalizations. These are followed by marked increases in death and rehospitalization rates, which then decline exponentially though they remain higher than in patients without a recent hospitalization. Therefore, optimal management of patients with acute heart failure before discharge and in the early post-discharge phase is critical. First, it may prevent rehospitalizations through the early detection and effective treatment of residual or recurrent congestion, the main manifestation of decompensation. Second, initiation at pre-discharge and titration to target doses in the early post-discharge period, of guideline-directed medical therapy may improve both short- and long-term outcomes. Third, in chronic heart failure, medical treatment is often left unchanged, so the acute heart failure hospitalization presents an opportunity for implementation of therapy. The aim of this scientific statement by the Heart Failure Association of the European Society of Cardiology is to summarize recent findings that have implications for clinical management both in the pre-discharge and the early post-discharge phase after a hospitalization for acute heart failure. |
| Keywords: | Acute heart failure Pre-discharge Early post-discharge Management Prognosis |