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Management of Acute Heart Failure during an Early Phase.

ABSTRACT: Acute heart failure (AHF), a global pandemic with high morbidity and mortality, exerts a considerable economic burden. AHF includes a broad spectrum of clinical presentations ranging from new-onset heart failure to cardiogenic shock. Key elements of the management rely on the clinical diagnosis confirmed on, both, increased natriuretic peptides and echocardiography, and on the prompt initiation of oxygen therapy, including non-invasive positive pressure ventilation, vasodilators, and diuretics. A care pathway is essential, specifically when an acute coronary syndrome is suspected or in the case of cardiogenic shock. Association or increasing doses of vasopressors despite an adequate volume status are markers of progression toward a refractory cardiogenic shock state. For the latter, mechanical circulatory support should be initiated early, optimally before the onset of renal or liver failure. Thus, a tertiary care center is recommended for the management of patients with AHF who require percutaneous coronary intervention or mechanical circulatory support. This narrative review provides multidisciplinary guidance for the management of AHF and cardiogenic shock from pre-hospital to intensive care unit/cardiac care unit, based on contemporary evidence and expert opinion.

SUBMITTER: Takagi K

PROVIDER: S-EPMC9536658 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Management of Acute Heart Failure during an Early Phase.

Takagi Koji K Kimmoun Antoine A Sato Naoki N Mebazaa Alexandre A

International journal of heart failure 20200417 2

Acute heart failure (AHF), a global pandemic with high morbidity and mortality, exerts a considerable economic burden. AHF includes a broad spectrum of clinical presentations ranging from new-onset heart failure to cardiogenic shock. Key elements of the management rely on the clinical diagnosis confirmed on, both, increased natriuretic peptides and echocardiography, and on the prompt initiation of oxygen therapy, including non-invasive positive pressure ventilation, vasodilators, and diuretics. ...[more]

PMID: 36263292

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Project description:ObjectivesWe sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF) as part of the Gulf aCute heArt failuRe rEgistry (CARE) project.MethodsData were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012.ResultsThe mean age of our patients was 63±12 years. Over half (57%) were male and 95% were Omani citizens. Fifty-seven percent of patients presented with acute decompensated chronic heart failure (ADCHF) while 43% had new-onset AHF. The primary comorbid conditions were hypertension (72%), coronary artery disease (55%), and diabetes mellitus (53%). Ischemic heart disease (IHD), hypertensive heart disease, and idiopathic cardiomyopathy were the most common etiologies of AHF in Oman. The median left ventricular ejection fraction of the cohort was 36% (27-45%) with 56% of the patients having heart failure with reduced ejection fraction (< 40%). Atrial fibrillation was seen in 15% of patients. Acute coronary syndrome (ACS) and non-compliance with medications were the most common precipitating factors. At discharge, angiotensin converting enzyme inhibitors and beta-blockers were prescribed adequately, but aldosterone antagonists were under prescribed. Within 12-months follow-up, one in two patients were rehospitalized for AHF. In-hospital mortality was 7.1%, which doubled to 15.7% at three months and reached 26.4% at one-year post discharge.ConclusionsOman CARE was the first prospective multicenter registry of AHF in Oman and showed that heart failure (HF) patients present at a younger age with recurrent ADCHF and HF with reduced ejection fraction. IHD was the most common etiology of HF with a low prevalence of AHF, but a high prevalence of acute coronary syndrome and non-compliance with medications precipitating HF. A quarter of patients died at one-year follow-up even though at discharge medical therapy was nearly optimal. Our study indicates an urgent need for prevention, early diagnosis, and treatment of AHF in Oman.

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Management of Acute Heart Failure during an Early Phase.

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Management of Acute Heart Failure during an Early Phase.

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