Treatment of Acute Heart Failure in the ED
Millions of patients are hospitalized for acute heart failure (AHF) every year throughout the world. Despite tremendous advances in cardiovascular care, morbidity and mortality for AHF remain high, consuming billions of health care dollars. With the aging of the population, the incidence and prevalence of HF is projected to increase. Yet, initial treatment of AHF today is similar to 40 years ago. Multiple studies have yielded new insights regarding initial management, with regards to both treatment and strategies of care. These advances will be reviewed in the context of initial or early AHF management. There remains, however, an unmet need to improve outcomes for AHF patients.
In 1974, Ramirez and Abelmann described the management of cardiac decompensation, or acute heart failure (AHF), in the New England Journal of Medicine. The early treatment of AHF in the emergency department (ED) remains largely the same today. Nesiritide, the only new drug approved for AHF in the last 10 years, is not commonly prescribed.
Traditionally used therapies, such as loop diuretics and vasodilators, continue to be the primary treatments of AHF in the ED. At the present time, there are no Class I, Level A (best evidence) guideline recommendations for the early pharmacologic treatment of AHF, though there are numerous smaller studies supporting or refuting commonly used therapies. Lessons learned from clinical trials, registries and multiple smaller studies provide important insights into initial management. In this review, we describe current best practices, highlight areas of controversy, and discuss the exciting hypotheses that are currently being explored and investigated.
Abstract and Introduction
Abstract
Millions of patients are hospitalized for acute heart failure (AHF) every year throughout the world. Despite tremendous advances in cardiovascular care, morbidity and mortality for AHF remain high, consuming billions of health care dollars. With the aging of the population, the incidence and prevalence of HF is projected to increase. Yet, initial treatment of AHF today is similar to 40 years ago. Multiple studies have yielded new insights regarding initial management, with regards to both treatment and strategies of care. These advances will be reviewed in the context of initial or early AHF management. There remains, however, an unmet need to improve outcomes for AHF patients.
Introduction
In 1974, Ramirez and Abelmann described the management of cardiac decompensation, or acute heart failure (AHF), in the New England Journal of Medicine. The early treatment of AHF in the emergency department (ED) remains largely the same today. Nesiritide, the only new drug approved for AHF in the last 10 years, is not commonly prescribed.
Traditionally used therapies, such as loop diuretics and vasodilators, continue to be the primary treatments of AHF in the ED. At the present time, there are no Class I, Level A (best evidence) guideline recommendations for the early pharmacologic treatment of AHF, though there are numerous smaller studies supporting or refuting commonly used therapies. Lessons learned from clinical trials, registries and multiple smaller studies provide important insights into initial management. In this review, we describe current best practices, highlight areas of controversy, and discuss the exciting hypotheses that are currently being explored and investigated.
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