Management of acute heart failure-Is there a paradigm shift around the corner?

C. Pater, T. Severin

Novartis Pharma AG, Basel, Switzerland.

DOI: 10.4236/wjcd.2013.32A001                

Abstract

It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation. Guidelines on AHF management have highlighted that the currently administered AHF therapies lack evidence and have raised concerns on the safety and efficacy of some of the hitherto accepted treatment modalities. Additionally, the high mortality and morbidity rates associated with the current AHF therapies also add to the imperative need to revisit AHF management. The last decade has witnessed a paradigm shift in the way we define and diagnose AHF. Apart from it being recognized as a distinct clinical entity, research has also led to new data on the pathophysiological changes associated with AHF. These developments along with the limited short- and long-term effects of currently used therapies may herald a paradigm shift in the way we plan and deliver management strategies to treat the pathological progression of heart failure.

Keywords

Acute Heart Failure; Hemodynamic; Clinical and Residual Congestion; Vasodilators; Diuretics; Management Strategies

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sato, N., Kajimoto, K., Asai, K., et al. (2010) Acute decompensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: Rationale, design, and preliminary data. American Heart Journal, 159, 949-955. doi:10.1016/j.ahj.2010.03.019
[2]	Collins, S.P., Pang, P.S., Lindsell, C.J., et al. (2010) International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes. European Journal of Heart Failure, 12, 1253-1260. doi:10.1093/eurjhf/hfq133
[3]	Adams Jr., K.F., Fonarow, G.C., Emerman, C.L., et al. (2005) 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). American Heart Journal, 149, 209216. doi:10.1016/j.ahj.2004.08.005
[4]	Cleland, J.G., Swedberg, K., Follath, F., et al. (2003) The EuroHeart Failure survey programme—A survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis. European Heart Journal, 24, 442-463. doi:10.1016/S0195-668X(02)00823-0
[5]	Richard Hobbs, F.D. (2010) Clinical burden and health service challenges of chronic heart failure. British Journal of General Practice, 60, 611-615. doi:10.3399/bjgp10X515133
[6]	Lloyd-Jones, D., Adams, R.J., Brown, T.M., et al. (2010) Heart disease and stroke statistics—2010 update: A report from the American Heart Association. Circulation, 121, e46-e215. doi:10.1161/CIRCULATIONAHA.109.192667
[7]	Roger, V.L., Go, A.S., Lloyd-Jones, D.M., et al. (2012) Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation, 125, e2-e220. doi:10.1161/CIR.0b013e31823ac046
[8]	Gheorghiade, M., Abraham, W.T., Albert, N.M., et al. (2006) Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. Journal of the American Medical Association, 296, 2217-2226. doi:10.1001/jama.296.18.2217
[9]	Nieminen, M.S., Brutsaert, D., Dickstein, K., et al. (2006) EuroHeart Failure Survey II (EHFS II): A survey on hospitalized acute heart failure patients: Description of population. European Heart Journal, 27, 2725-2736. doi:10.1093/eurheartj/ehl193
[10]	Parissis, J.T., Ikonomidis, I., Rafouli-Stergiou, P., et al. (2011) Clinical characteristics and predictors of in-hospital mortality in acute heart failure with preserved left ventricular ejection fraction. Journal of the American Medical Association, 107, 79-84. doi:10.1016/j.amjcard.2010.08.044
[11]	Ross, J.S., Chen, J., Lin, Z., et al. (2010) Recent national trends in readmission rates after heart failure hospitalization. Circulation: Heart Failure, 3, 97-103. doi:10.1161/CIRCHEARTFAILURE.109.885210
[12]	Hunt, S.A., Abraham, W.T., Chin, M.H., et al. (2009) 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology, 53, e1-e90. doi:10.1016/j.jacc.2008.11.013
[13]	Dickstein, K., Cohen-Solal, A., Filippatos, G., et al. (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). European Heart Journal, 29, 2388-2442. doi:10.1093/eurheartj/ehn309
[14]	O’Connell, J.B. (2000) The economic burden of heart failure. Clinical Cardiology, 23, III6-III10. doi:10.1002/clc.4960231503
[15]	Howlett, J.G., Johnstone, D.E., Sketris, I., et al. (2003) Identifying opportunities to address the congestive heart failure burden: The Improving Cardiovascular Outcomes in Nova Scotia (ICONS) study. Canadian Journal of Cardiology, 19, 439-444.
[16]	Howlett, J.G., McKelvie, R.S., Arnold, J.M., et al. (2009) Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials. Canadian Journal of Cardiology, 25, 85-105. doi:10.1016/S0828-282X(09)70477-5
[17]	Jencks, S.F., Williams, M.V. and Coleman, E.A. (2009) Rehospitalizations among patients in the Medicare fee-for-service program. The New England Journal of Medicine, 360, 1418-1428. doi:10.1056/NEJMsa0803563
[18]	Remme, W.J., McMurray, J.J., Rauch, B., et al. (2005) Public awareness of heart failure in Europe: First results from SHAPE. European Heart Journal, 26, 2413-2421. doi:10.1093/eurheartj/ehi447
[19]	Drazner, M.H., Hellkamp, A.S., Leier, C.V., et al. (2008) Value of clinician assessment of hemodynamics in advanced heart failure: The ESCAPE trial. Circulation: Heart Failure, 1, 170-177. doi:10.1161/CIRCHEARTFAILURE.108.769778
[20]	Remes, J., Miettinen, H., Reunanen, A. and Pyorala, K. (1991) Validity of clinical diagnosis of heart failure in primary health care. European Heart Journal, 12, 315321.
[21]	Marcus, G.M., Gerber, I.L., McKeown, B.H., et al. (2005) Association between phonocardiographic third and fourth heart sounds and objective measures of left ventricular function. Journal of the American Medical Association, 293, 2238-2244. doi:10.1001/jama.293.18.2238
[22]	Stevenson, L.W. and Perloff, J.K. (1989) The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. Journal of the American Medical Association, 261, 884-888. doi:10.1001/jama.1989.03420060100040
[23]	Chakko, S., Woska, D., Martinez, H., et al. (1991) Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: Conflicting results may lead to inappropriate care. American Journal of Medicine, 90, 353-359.
[24]	Januzzi Jr., J.L., Camargo, C.A., Anwaruddin, S., et al. (2005) The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Journal of the American Medical Association, 95, 948-954. doi:10.1016/j.amjcard.2004.12.032
[25]	Zaphiriou, A., Robb, S., Murray-Thomas, T., et al. (2005) The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study. European Journal of Heart Failure, 7, 537-541. doi:10.1016/j.ejheart.2005.01.022
[26]	McMurray, J.J., Adamopoulos, S., Anker, S.D., et al. (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33, 1787-1847. doi:10.1093/eurheartj/ehs104
[27]	Richter, C.A., Kalenga, J.C., Rowe, B.H., et al. (2009) Practice patterns and outcomes in patients presenting to the emergency department with acute heart failure. Canadian Journal of Cardiology, 25, e173-e178. doi:10.1016/S0828-282X(09)70092-3
[28]	Gattis, W.A. and O’Connor, C.M. (2004) Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure. Journal of the American Medical Association, 93, 74B-76B. doi:10.1016/j.amjcard.2004.01.019
[29]	Peacock, W.F., Fonarow, G.C., Emerman, C.L., et al. (2007) Impact of early initiation of intravenous therapy for acute decompensated heart failure on outcomes in ADHERE. Cardiology, 107, 44-51. doi:10.1159/000093612
[30]	Peacock, W.F., Emerman, C., Costanzo, M.R., et al. (2009) Early vasoactive drugs improve heart failure outcomes. Congestive Heart Failure, 15, 256-264. doi:10.1111/j.1751-7133.2009.00112.x
[31]	Cotter, G., Metra, M., Milo-Cotter, O., et al. (2008) Fluid overload in acute heart failure-re-distribution and other mechanisms beyond fluid accumulation. European Journal of Heart Failure, 10, 165-169. doi:10.1016/j.ejheart.2008.01.007
[32]	Gheorghiade, M., Follath, F., Ponikowski, P., et al. (2010) Assessing and grading congestion in acute heart failure: A scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. European Journal of Heart Failure, 12, 423-433. doi:10.1093/eurjhf/hfq045
[33]	Nieminen, M.S., Bohm, M., Cowie, M.R., et al. (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Revista Española de Cardiología, 58, 389-429. doi:10.1157/13073896
[34]	Gheorghiade, M., Filippatos, G., De, L.L. and Burnett, J. (2006) Congestion in acute heart failure syndromes: An essential target of evaluation and treatment. American Journal of Medicine, 119, S3-S10. doi:10.1016/j.amjmed.2006.09.011
[35]	Adamson, P.B., Magalski, A., Braunschweig, F., et al. (2003) Ongoing right ventricular hemodynamics in heart failure: Clinical value of measurements derived from an implantable monitoring system. Journal of the American College of Cardiology, 41, 565-571. doi:10.1016/S0735-1097(02)02896-6
[36]	Gheorghiade, M. and Filippatos G. (2005) Reassessing treatment of acute heart failure syndromes: The adhere registry. European Heart Journal, 7, B13-B17. doi:10.1093/eurheartj/sui008
[37]	The ADHERE Registry. (2004) First Quarter 2004 National Benchmark Report. Fremont, Scios Inc., CA.
[38]	Von Lueder, T.G. and Krum, H. (2012) Current modalities for invasive and non-invasive monitoring of volume status in heart failure. Heart, 98, 967-973. doi:10.1136/heartjnl-2011-301330
[39]	Nohria, A., Tsang, S.W., Fang, J.C., et al. (2003) Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. Journal of the American College of Cardiology, 41, 1797-1804. doi:10.1016/S0735-1097(03)00309-7
[40]	Arnold, J.M., Howlett, J.G., Dorian, P., et al. (2007) Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers. Canadian Journal of Cardiology, 23, 21-45. doi:10.1016/S0828-282X(07)70211-8
[41]	Aronson, D. and Burger, A.J. (2010) The relationship between transient and persistent worsening renal function and mortality in patients with acute decompensated heart failure. Journal of Cardiac Failure, 16, 541-547. doi:10.1016/j.cardfail.2010.02.001
[42]	Logeart, D., Tabet, J.Y., Hittinger, L., et al. (2008) Transient worsening of renal function during hospitalization for acute heart failure alters outcome. International Journal of Cardiology, 127, 228-232. doi:10.1016/j.ijcard.2007.06.007
[43]	Fonarow, G.C., Abraham, W.T., Albert, N.M., et al. (2004) Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): Rationale and design. American Heart Journal, 148, 43-51. doi:10.1016/j.ahj.2004.03.004
[44]	Hernandez, A.F., Greiner, M.A., Fonarow, G.C., et al. (2010) Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. Journal of the American Medical Association, 303, 1716-1722. doi:10.1001/jama.2010.533
[45]	McDonald, K., Conlon, C., and Ledwidge, M. (2007) Disease management programs for heart failure: Not just for the “sick” heart failure population. European Journal of Heart Failure, 9, 113-117. doi:10.1016/j.ejheart.2006.05.005