Acute Heart Failure Syndromes (original) (raw)
Abstract
; for the International Working Group on Acute Heart Failure Syndromes A cute heart failure syndromes (AHFS) poses unique diagnostic and management challenges. This syndrome has recently received attention from researchers, clinicians, regulatory agencies, and the pharmaceutical industry. However, there is no consensus on its definition, epidemiology, pathophysiology, appropriate therapeutic options, and directions for future research. This document is the result of the First and Second International Workshop on Acute Heart Failure Syndrome that took place in May 2004 and April 2005. At these workshops, a selected group of physician scientists, epidemiologists, clinicians, regulatory and governmental funding agencies, and industry representatives from North and South America and Europe convened to develop a platform for future investigative approaches and management of AHFS. Subsequently, emergency physicians, who play a pivotal role in the early management of AHFS, contributed to this document. Definition AHFS is defined as gradual or rapid change in heart failure (HF) signs and symptoms resulting in a need for urgent therapy. These symptoms are primarily the result of severe pulmonary congestion due to elevated left ventricular (LV) filling pressures (with or without low cardiac output). AHFS can occur in patients with preserved or reduced ejection fraction (EF). Concurrent cardiovascular conditions such as coronary heart disease (CHD), hypertension, valvular heart disease, atrial arrhythmias, and/or noncardiac conditions (including renal dysfunction, diabetes, anemia) are often present and may precipitate or contribute to the pathophysiology of this syndrome. 1-3 Epidemiology Until recently, the clinical characteristics, management patterns, and outcomes of patients hospitalized with AHFS have
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References (39)
- Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J, for the Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Euro Heart Failure Survey Programme: a survey on the quality of care among patients with heart failure in Europe, part 1: patient characteristics and diagnosis. Eur Heart J. 2003;24:442-463.
- Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP, for the ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149:209 -216.
- Fonarow GC, Abraham WT, Albert N, Gattis W, Gheorghiade M, Greenberg B, O'Connor CM, She L, Yancy CW, Young JB. Impact of evidence-based heart failure therapy use at hospital discharge on treatment rates during follow-up: a report from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol. 2005;45:345A.
- American Heart Association. Heart Disease and Stroke Statistics: 2005 Update. Dallas, Tex: American Heart Association; 2005.
- Cuffe MS, Califf RM, Adams KF Jr, Benza R, Bourge R, Colucci WS, Massie BM, O'Connor CM, Pina I, Quigg R, Silver MA, Gheorghiade M, for the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Effects of short-term, intravenous milrinone on acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287: 1541-1547.
- Publication Committee for the VMAC Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287:1531-1540.
- Komajda M, Follath F, Swedberg K, Cleland J, Aguilar JC, Cohen-Solal A, Dietz R, Gavazzi A, Van Gilst WH, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, Widimsky J, Freemantle N, Eastaugh J, Mason J, for the Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Euro Heart Failure Survey Programme: a survey on the quality of care among patients with heart failure in Europe, part 2: treatment. Eur Heart J. 2003;24:464 -474.
- Gheorghiade M, Klein L, Abraham W, Albert NM, Greenberg BH, O'Connor CM, She L, Stough S, Yancy CW, Young JB, Fonarow GC. The relation between admission systolic blood pressure and outcomes in hospitalized patients with heart failure with reduced or preserved systolic function: an OPTIMIZE-HF analysis. Circulation. 2005;112(suppl II): II-599. Abstract.
- Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577-585.
- Horwich TB, Patel J, MacLellan WR, Fonarow GC. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dys- function, and increased mortality rates in advanced heart failure. Circu- lation. 2003;108:833-838.
- Rubboli A, Sobotka PA, Euler DE. Effect of acute edema on left ven- tricular function and coronary vascular resistance in the isolated rat heart. Am J Physiol. 1994;267:H1054 -H1061.
- Steimle AE, Stevenson LW, Chelimsky-Fallick C, Fonarow GC, Hamilton MA, Moriguchi JD, Kartashov A, Tillisch JH. Sustained he- modynamic efficacy of therapy tailored to reduce filling pressures in survivors with advanced heart failure. Circulation. 1997;96:1165-1172.
- Katz AM. A new inotropic drug: its promise and a caution. N Engl J Med. 1978;299:1409 -1410.
- Felker GM, Benza RL, Chandler AB, Leimberger JD, Cuffe MS, Califf RM, Gheorghiade M, O'Connor CM, for the OPTIME-CHF Investi- gators. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41:997-1003.
- Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ, for the ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in heart failure using classification and regression tree (CART) methodology: analysis of 33,046 patients in the ADHERE registry. JAMA. 2005;293:572-580.
- Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med. 2004;116:466 -473.
- Francis GS, Siegel RM, Goldsmith SR, Olivari MT, Levine TB, Cohn JN. Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure: activation of the neurohumoral axis. Ann Intern Med. 1985;103:1-6.
- Emerman CL, De Marco T, Constanzo MR, Peacock WF, for the ADHERE Scientific Advisory Committee. Impact of intravenous diuret- ics on the outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE Registry. J Card Fail. 2004; 10:S116.
- Schulz R, Rose J, Martin C, Brodde OE, Heusch G. Development of short-term myocardial hibernation: its limitation by the severity of ische- mia and inotropic stimulation. Circulation. 1993;88:684 -695.
- Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TL, Cheng ML, Wynne J, for the ADHERE Scientific Advisory Committee and Investigators and ADHERE Study Group. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: analysis from the Acute Decom- pensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46:57-64.
- Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K. Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA. 2005;293: 1900 -1905.
- Sackner-Bernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation. 2005;111:1487-1491.
- Felker GM, Leimberger JD, Califf RM, Cuffe MS, Massie BM, Adams KF Jr, Gheorghiade M, O'Connor CM. Risk stratification after hospital- ization for decompensated heart failure. J Card Fail. 2004;10:460 -466.
- Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290:2581-2587.
- Klein L, O'Connor CM, Leimberger JD, Gattis-Stough W, Pina IL, Felker GM, Adams KF Jr, Califf RM, Gheorghiade M, for the OPTIME-CHF Investigators. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the OPTIME-CHF study. Circulation. 2005;111:2454 -2460.
- Maisel A, Hollander JE, Guss D, McCullough P, Nowak R, Green G, Saltzberg M, Ellison SR, Bhalla MA, Bhalla V, Clopton P, Jesse R, for the Rapid Emergency Department Heart Failure Outpatient Trial Inves- tigators. Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT): a multicenter study of B-type natri- uretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath. J Am Coll Cardiol. 2004;44:1328 -1333.
- Felker GM, Gattis WA, Leimberger JD, Adams KF, Cuffe MS, Gheorghiade M, O'Connor CM. Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure. Am J Cardiol. 2003;92:625-628.
- Benza RL, Tallaj JA, Felker GM, Zabel KM, Kao W, Bourge RC, Pearce D, Leimberger JD, Borzak S, O'Connor CM, Gheorghiade M, for the OPTIME-CHF Investigators. Arrhythmias in acute decompensated heart failure: results from the OPTIME-CHF study. J Card Fail. 2004;10: 279 -284.
- Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, Shaham O, Marghitay D, Koren M, Blatt A, Moshkovitz Y, Zaidenstein R, Golik A. Randomized trial of high-dose isosorbide dininitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary edema. Lancet. 1998;351: 389 -393.
- Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K, Harjola VP, Mitrovic V, Abdalla M, Sandell EP, Lehtonen L, for the Steering Committee and Investigators of the Levosimendan Infusion versus Do- butamine (LIDO) Study. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet. 2002;360:196 -202.
- Packer M, Mebazza A. Randomized evaluations of levosimendan (REVIVE II) and survival of patients with acute heart failure in need of intravenous inotropic support (SURVIVE). Presented at the 2005 American Heart Association Scientific Sessions, Dallas, Tex, November 13-16, 2005.
- Imai M, Gheorghiade M, Cowart D, Zhang D, Amato A, Carminati P, Sabbah HN. Intravenous istaroxime improves left ventricular systolic function in dogs with advanced heart failure without increasing myo- cardial oxygen consumption. J Card Fail. 2005;11:S95.
- Gheorghiade M, Gattis WA, O'Connor CM, Adams KF Jr, Elkayam U, Barbagelata A, Ghali JK, Benza RL, McGrew FA, Klapholz M, Ouyang J, Orlandi C, for the Acute and Chronic Therapeutic Impact of a Vaso- pressin Antagonist in Congestive Heart Failure (ACTIV in CHF) Inves- tigators. Effects of tolvaptan, a vasopressin antagonist, in patients hospi- talized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291:1963-1971.
- Udelson JE, Smith WB, Hendrix GH, Painchaud CA, Ghazzi M, Thomas I, Ghali JK, Selaru P, Chanoine F, Pressler ML, Konstam MA. Acute hemodynamic effects of conivaptan, a dual V1A and V2 vasopressin receptor antagonist, in patients with advanced heart failure. Circulation. 2001;104:2417-2423.
- Gottlieb SS, Brater DC, Thomas I, Havranek E, Bourge R, Goldman S, Dyer F, Gomez M, Bennett D, Ticho B, Beckman E, Abraham WT. BG9719 (CVT-124), an A1 adenosine receptor antagonist, protects against the decline in renal function observed with diuretic therapy. Circulation. 2002;105:1348 -1353.
- Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Phy- sicians and the International Society for Heart and Lung Transplantation; endorsed by the Heart Rhythm Society. Circulation. 2005;112: 1825-1852.
- Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Levy S, Linde C, Lopez-Sendon JL, Nieminen MS, Pierard L, Remme WJ, for the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J. 2005;26:1115-1140.
- Nieminen MS, Bohm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, Hasin Y, Lopez-Sendon J, Mebazaa A, Metra M, Rhodes A, Swedberg K, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie MR, Dean V, Deckers J, Burgos EF, Lekakis J, Lindahl B, Mazzotta G, Morais J, Oto A, Smiseth OA, Garcia MA, Dickstein K, Albuquerque A, Conthe P, Crespo-Leiro M, Ferrari R, Follath F, Gavazzi A, Janssens U, Komajda M, Morais J, Moreno R, Singer M, Singh S, Tendera M, Thygesen K, for the ESC Committee for Practice Guideline (CPG). Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Car- diology. Eur Heart J. 2005;26:384 -416.
- KEY WORDS: heart failure Ⅲ coronary disease Ⅲ morbidity Ⅲ mortality