Acute decompensated heart failure (ADHF) is defined as the sudden or gradual onset of heart failure signs or symptoms. These include severe breathlessness, rapid weight gain, and fluid build-up in the lungs and around the body. The condition requires a doctor’s care, which leads to unplanned office appointments, emergency room visits, hospitalization and readmission.
Patients almost universally experience pulmonary and systemic congestion as a result of increased left- and right-heart filling pressure. Decreased cardiac output activates the renin-angiotensin-aldosterone system (RAAS), which controls blood pressure and fluid balance. This activation forces the heart to work harder to supply the body with blood, and the heart failure worsens. Continued occurrences damage vital organs, such as the heart and kidneys, decreasing the chance of the patient surviving another episode.
Current therapies for Acute Decompensated Heart Failure (ADHF) are decades old and are primarily directed at relieving symptoms of congestion followed by end-organ perfusion and function.5 Treatment options include:
• Loop diuretics, which may worsen renal function and be associated with worse outcomes, including mortality when
given in high doses. In addition, 20-30% of heart failure patients develop diuretic resistance.
• Vasodilators improve renal flow, which reduces afterload and its associated myocardial wall stress, oxygen demand,
and negative impact on output.
• Inotropes, which increase contractility but have not been shown to improve outcomes and roughly double
1. Krumholz HM, Merrill AR, Schone EM, et al. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes. 2009;2(5):407–413. 2. Michota FA Jr, Amin A. Bridging the gap between evidence and practice in acute decompensated heart failure management. J Hosp Med. 2008;3(suppl):S7-S15. 3. Ahmed A, Allman RM, Fonarow GC, Love TE, Zannad F, Dell’italia LJ, et al. Incident heart failure hospitalization and subsequent mortality in chronic heart failure: a propensity-matched study. J Card Fail 2008;14(3):211–8. 4. Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation 2007;116(13):1482–7. 5. Majure DT, Teerlink JR. Update in management of acute decompensated heart failure. Current Treatment Options in Cardiovascular Medicine. 2011 Oct 6. 6. Mebazaa A, Parissis J, Porcher R, Gayat E, Nikolaou M, et al. (2011) Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods. Intensive Care Med 37: 290–301 doi:10.1007/s00134-010-2073-4.
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