Acute decompensated heart failure update

Abstract

Acute decompensated heart failure (ADHF) continues to increase in prevalence and is associated with substantial mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than eight million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The increase in the prevalence and cost of HF is primarily the result of shifting demographics and a growing population. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that a growing number of studies began to address the management of ADHF. It is the intent of this review to update the clinician regarding the evaluation and optimal management of ADHF.

Fig. (1)

Algorithm for managing acute decompensated heart failure. CTZ = chlorothiazide, HCTZ = hydrochlorothiazide, IV = intravenous, MAP = mean arterial pressure, NES = nesiritide, NTG = nitroglycerin, NTP = nitroprusside, PAC = pulmonary artery catheter, PCWP = pulmonary capillary wedge pressure, PO = oral, PTA = prior to admission, SBP = systolic blood pressure, UOP = urine output.