Hospital Management of Acute Decompensated Heart Failure

Heart failure (HF) is one of the leading causes of hospitalizations for elderly adults in the United States. One in 5 Americans will be >65 years of age by 2050. Because of the high prevalence of HF in this group, the number of Americans requiring hospitalization for this disorder is expected to rise significantly. We reviewed the most recent and ongoing studies and recommendations for the management of patients hospitalized due to decompensated HF. The Acute Decompensated Heart Failure National Registry, together with the 2013 American College of Cardiology Foundation and American Heart Association heart failure guidelines, earlier retrospective and prospective studies including the Diuretic Optimization Strategies Evaluation (DOSE), the Trial of Intensified vs Standard Medical Therapy in the Elderly Patients With Congestive Heart Failure (TIME-CHF), the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE–HF), the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) and the Comparison of Medical, Pacing and Defibrillation Therapies in Heart Failure (COMPANION) trial were reviewed for current practices pertaining to these patients. Gaps in our knowledge of optimal use of patient-specific information (biomarkers and comorbid conditions) still exist.     

Medical Therapy for Acute Decompensated Heart Failure: What Recent Clinical Trials Have Taught Us About Diuretics and Vasodilators

Diuretics and vasodilators have been the cornerstone of heart failure (HF) therapy for decades. Although not shown to reduce mortality, diuretic and vasodilator therapy remain commonplace for treating acute decompensated HF, with diuretics being the mainstay of therapy for the removal of excess fluid in all patients with HF. This article discusses results of recent trials concerning diuretic or vasodilator therapy and HF, including the Diuretic Optimization Strategies Evaluation (DOSE) trial, the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT), and the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST), as well as results from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial and the Preliminary Study of Relaxin in Acute Heart Failure (Pre-RELAX-AHF).     

Future challenges in quality improvement in heart failure

This is the final installment in a series reporting on the Centers for Medicare & Medicaid Services (CMS) initiatives to improve care for Medicare beneficiaries with heart failure through its Quality Improvement Organization (QIO) contractors during the 1999-2002 contract cycle. Previous columns have reported on a nation-wide hospital-based effort, the National Heart Failure project, and a more limited outpatient-based effort, the Heart Failure Practice Improvement Effort. After 3 years of experience with the National Heart Failure project, it is appropriate to highlight the issues pertinent to future quality improvement initiatives in heart failure care.     

Facteurs associés à l'inclusion des patients dans le programme PRADO - Insuffisance Cardiaque : étude cas-témoin au Centre Hospitalier de Troyes en 2017–2018

ObjectivesIn 2013, the French National Health Insurance set up a programme to help patients with heart failure to return home and stay there (PRADO). During a hospitalization for cardiac decompensation, the medical team decides on the inclusion of the patient in the programme based on eligibility criteria defined. The objective of this study was to identify the factors most associated with the inclusion of heart failure patients in the PRADO program.Materials and MethodsThis was a monocentric retrospective analytical stratified case-control study. It focused on the analysis of patient records hospitalized for cardiac decompensation between 01/01/2017 and 31/12/2018 in the cardiology department of the Centre Hospitalier de Troyes. For each patient included in the PRADO Heart Failure programme, one or two controls, not included in the PRADO Heart Failure programme were matched. The matching was exact without discounting. It was performed on the following criteria: age in 10-year increments, sex, main diagnosis of the stay, major category of diagnosis of the stay and its type (medical or surgical), the severity score of the Homogeneous Group of Patients of the stay and the Charlson score.ResultsA total of 40 patients included in PRADO Heart Failure were matched to 56 controls not included in PRADO Heart Failure. Patients with respiratory disease (3.77 [1.07 – 13.29]), as well as patients on renin-angiotensin system inhibitors (2.24 [1.61 – 5.31]) were more often included in the PRADO Heart Failure programme. The most frequent criteria for non-eligibility were the need to transfer the patient to a specialised institution and significant impairment of higher functions.ConclusionRespiratory comorbidity and renin-angiotensin system blocker treatment are the factors most associated with the inclusion of heart failure patients in the PRADO Heart Failure programme.     

2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure: Executive Summary

BackgroundThe 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America (AHA/ACC/HFSA) Guideline for the Management of Heart Failure replaces the 2013 ACCF/AHA Guideline for the Management of Heart Failure and the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose and manage patients with heart failure.MethodsA comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews and other evidence conducted in human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies published through September 2021 were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021.Results and ConclusionsHeart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments that have high-quality published economic analyses.     

Profiles of quality improvements in heart failure care

The Health Care Financing Administration, with its National Heart Failure project, has made heart failure care one of its targets for quality improvement. Previous columns have highlighted the clinical and epidemiologic background for the National Heart Failure project. This column provides "real-world" examples of hospitals improving care for their heart failure patients. (c)2001 by CHF, Inc.     

The roles of epicardial adipose tissue in heart failure

Heart Failure Reviews - Heart failure is a growing health problem resulting in the decreased life expectancy of patients and severely increased the healthcare burden. Penetrating research on the...     

Guidelines for the Evaluation and Management of Heart Failure

Report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure).     

Biomarkers for the diagnosis and management of heart failure

Heart Failure Reviews - Heart failure (HF) is a significant cause of morbidity and mortality worldwide. Circulating biomarkers reflecting pathophysiological pathways involved in HF development and...     

Effects of catheter-based renal denervation on heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials

Heart Failure Reviews - Despite the major progress in the treatment of heart failure, the burden of heart failure is steadily increasing in the Western world. Heart failure is characterized by...     

Cardiovascular magnetic resonance for the diagnosis and management of heart failure with preserved ejection fraction

Heart Failure Reviews - Heart failure with preserved ejection fraction (HFpEF) is characterized by an impaired ventricular filling resulting in the development of dyspnea and other HF symptoms....     

Coenzyme Q10 and Utility in Heart Failure: Just Another Supplement?

Current Heart Failure Reports - Heart failure affects 5.1 million people in the USA annually. It accounts for a frequent cause of hospitalizations and disability. Patients with congestive heart...     

Is it time to revisit ICD indications?

Heart Failure Reviews -     

Correction to: Polypharmacy definition and prevalence in heart failure: a systematic review

Heart Failure Reviews -     

Metabolic Therapy for Ischemic Heart Disease: The Rationale for Inhibition of Fatty Acid Oxidation

Heart Failure Reviews -     

Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF‑NETs) und Herzinsuffizienz-Einheiten („Heart Failure Units“, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz

Heart failure (HF) is associated with high mortality and frequent hospitalizations. With steadily increasing prevalence, costs also rise. To optimize HF treatment results, implementation of structured collaboration across all levels of care is required to ensure both high quality and continuity of treatment. Partners in this collaboration are general practitioners, cardiologists in private practice, regional hospitals and supraregional centers offering comprehensive state-of-the-art HF therapy including cardiovascular surgery. The German Cardiac Society (GCS) and the German Society for Thoracic and Cardiovascular Surgery (GSTCS) advocate implementation of modular Heart Failure Units (HFUs) organized within a Heart Failure Network (HF-NET) with verifiable quality characteristics featuring comprehensive and cooperative HF management across all levels of care. This position paper was prepared by the Commission on Clinical Cardiology of the GCS in collaboration with representatives from GCS and GSTCS, the German Association of Cardiologists in Private Practice (BNK) and the Working Group of Leading German Hospital Cardiologists (ALKK). It describes the requirements that should be met by the modules of a HF-NET to be eligible for certification as a Heart Failure Unit (HFU).     

Large animal models of heart failure with preserved ejection fraction

Heart Failure Reviews - Heart failure with preserved ejection fraction (HFpEF) is characterized by diastolic dysfunction and multiple comorbidities. The number of patients is continuously...     

Letter to the Editor regarding the article “SGLT2 inhibitors and cardiovascular and renal outcomes: a meta‑analysis and trial sequential analysis”

Heart Failure Reviews -     

Correction to: Intermittent levosimendan infusion in ambulatory patients with end-stage heart failure: a systematic review and meta-analysis of 984 patients

Heart Failure Reviews -     

Prognostic significance of T1 mapping parameters in heart failure with preserved ejection fraction: a systematic review

Heart Failure Reviews - Heart failure with preserved ejection fraction (HFpEF) accounts for almost one-half of all heart failure (HF) patients and continues to increase in prevalence. While...