Challenges in acute heart failure clinical management: optimizing care despite incomplete evidence and imperfect drugs - PubMed (original) (raw)

Review

Challenges in acute heart failure clinical management: optimizing care despite incomplete evidence and imperfect drugs

Sam L Teichman et al. Crit Pathw Cardiol. 2015 Mar.

Abstract

Acute heart failure is a common condition associated with considerable morbidity, mortality, and cost. However, evidence-based data on treating heart failure in the acute setting are limited, and current individual treatment options have variable efficacy. The healthcare team must often individualize patient care in ways that may extend beyond available clinical guidelines. In this review, we address the question, "How do you do the best you can clinically with incomplete evidence and imperfect drugs?" Expert opinion is provided to supplement guideline-based recommendations and help address the typical challenges that are involved in the management of patients with acute heart failure. Specifically, we discuss 4 key areas that are important in the continuum of patient care: differential diagnosis and risk stratification; choice and implementation of initial therapy; assessment of the adequacy of therapy during hospitalization or observation; and considerations for discharge/transition of care. A case study is presented to highlight the decision-making process throughout each of these areas. Evidence is accumulating that should help guide patients and healthcare providers on a path to better quality of care.

PubMed Disclaimer

Figures

FIGURE 1.

FIGURE 1.

Relationship of hospital mortality (%) to time of initial treatment (quartiles) and initial BNP levels being drawn (quartiles). BNP, brain natriuretic peptide; IV, intravenous. Reprinted with permission from Maisel et al. J Am Coll Cardiol. 2008;52:534–540.

FIGURE 2.

FIGURE 2.

Acute heart failure is a complex systemic disease involving multiple organ systems. BNP, brain natriuretic peptide; Cr, creatinine; CRP, C-reactive protein; CysC, cystatin C; LFTs, liver function tests; TNF, tumor necrosis factor.

References

    1. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–e319. -PubMed
    1. Lindenfeld J, Albert NM, Boehmer JP, et al. Heart Failure Society of America. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16:e1–e194.
    1. Go AS, Mozaffarian D, Roger VL, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292. -PMC -PubMed
    1. Heidenreich PA, Albert NM, Allen LA, et al. American Heart Association Advocacy Coordinating Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Stroke Council. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606–619. -PMC -PubMed
    1. Thygesen K, Mair J, Giannitsis E, et al. Study Group on Biomarkers in Cardiology of ESC Working Group on Acute Cardiac Care. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J. 2012;33:2252–2257. -PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources