Lessons learned in acute heart failure

Abstract

Acute heart failure (HF) is a global pandemic with more than one million admissions to hospital annually in the US and millions more worldwide. Post-discharge mortality and readmission rates remain unchanged and unacceptably high. Although recent drug development programmes have failed to deliver novel therapies capable of reducing cardiovascular morbidity and mortality in patients hospitalized for worsening chronic HF, hospitalized HF registries and clinical trial databases have generated a wealth of information improving our collective understanding of the HF syndrome. This review will summarize key insights from clinical trials in acute HF and hospitalized HF registries over the last several decades, focusing on improving the management of patients with HF and reduced ejection fraction.

Keywords: Acute heart failure; Clinical trial; Registry.

Figure 1

Mechanistic approach to heart failure in the vulnerable phase and thereafter. Our recommendation is in addition to the established guidelines by European and US professional societies for heart failure.^– We additionally recommend following established guidelines for coronary artery disease, arrhythmias, valvular heart disease, and non-cardiac co-morbidities ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor/neprilysin inhibitor; BB, beta-blocker; COPD, chronic obstructive pulmonary disease; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; MRA, mineralocorticoid receptor antagonist.

Figure 2

A visual summary of the US and European guidelines’ recommendations for the management of acute heart failure^– DVT, deep vein thrombosis; ECG, electrocardiogram; ICU, intensive care unit.