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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute decompensated heart failure is characterized by hemodynamic abnormalities as well as neuroendocrine activation, which contribute to heart failure symptoms, progressive cardiac dysfunction, and sudden death. The therapeutic goals in patients hospitalized with decompensated heart failure are to reverse acute hemodynamic abnormalities, relieve symptoms, and initiate treatment that will slow disease progression and improve long-term survival. Traditional hemodynamic targets in acute heart failure have been reduction in left and right ventricular filling pressures, reduction in systemic vascular resistance, and increase in cardiac output. Treatments aimed at these targets in patients with acute decompensated heart failure include diuretics, vasodilators, and inotropic agents. In patients hospitalized with acute decompensated heart failure, persistently elevated left ventricular filling pressure has been shown to be highly predictive of an increased risk of fatal decompensation and sudden death. Measures of systemic perfusion, arterial pressure, and vascular resistance have not. Thus, there is a more compelling physiologic rationale for the use of vasodilators than for inotropic agents in these patients. An ideal agent for acute decompensated heart failure would be one that rapidly reduces pulmonary wedge pressure, results in balanced arterial and venous dilation, promotes natriuresis, lacks direct positive inotropic effects, and does not result in reflex neuroendocrine activation.
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PMID:The treatment targets in acute decompensated heart failure. 1243 56

Acute decompensated heart failure (ADHF) is a common cause of hospitalizations. Intravenous nitroglycerin is widely used in the treatment of this condition. The use of this drug is based on its nitric oxide-mediated vasodilatory effect, which can lead to beneficial hemodynamic effects as well as improvement of myocardial ischemia and reduction of mitral regurgitation. However, information regarding the use of nitroglycerin for ADHF is limited to mostly hemodynamic evaluations in small groups of patients without cardiovascular outcome data. A single randomized, placebo controlled study that evaluated commonly used doses of nitroglycerin in patients with ADHF was disappointing and failed to show a significant hemodynamic effect or improvement of symptoms compared with placebo. The potential benefit of nitroglycerin seems to be limited by a decreased vasodilatory response in patients with heart failure, which requires an active titration of the drug and the use of high doses (>120 microg/min). In addition, the initial beneficial hemodynamic effect achieved with the appropriate dose of nitroglycerin is associated with neurohumoral activation and limited by an early development of nitrate tolerance that leads to a marked attenuation of the initial effect. More information obtained in large-scale studies that are appropriately designed to evaluate the effect of variable doses of nitroglycerin on short- and long-term cardiovascular outcome, with and without interventions shown to prevent nitrate tolerance, is needed before intravenous nitroglycerin can be recommended as a standard therapy for ADHF.
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PMID:Intravenous nitroglycerin in the treatment of decompensated heart failure: potential benefits and limitations. 1567 42

Acute decompensated heart failure (ADHF) has emerged as a major public health problem, and HF has become the leading cause of hospitalization in persons over 65 years of age. It is estimated that there are 6.5 million hospital days attributed to ADHF each year. Patients hospitalized with ADHF face a substantial risk of readmission, as high as 50% by 6 months after discharge. Despite the large number of patients hospitalized and this substantial risk, data on these patients have been limited and there has been little effort to improve the quality of care for patients hospitalized with ADHF. The Acute Decompensated Heart Failure National Registry (ADHERE) was designed to bridge this gap in knowledge and care by prospectively studying the characteristics, management, and outcomes of a broad spectrum of patients hospitalized with ADHF. Participating community and university hospitals identified patients with a primary or secondary discharge diagnosis of HF and collected medical history, management, treatments, and health outcomes via secure Web browser technology. As of October 2004, more than 160,000 patients from 281 hospitals have been enrolled. These patients differ substantially from those typically enrolled in randomized clinical trials. Initial data from the ADHERE registry have provided important insights into the clinical characteristics, patterns of care, and outcomes of patients with ADHF. ADHERE has documented significant delays in diagnosis and initiation of ADHF therapies as well as a substantial under-use of evidenced-based, guideline-recommended chronic HF therapies at hospital discharge. As such, there are substantial opportunities to improve the quality of care for ADHF patients in the nation's hospitals.
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PMID:Overview of acutely decompensated congestive heart failure (ADHF): a report from the ADHERE registry. 1580 15

Acute decompensated heart failure (ADHF) is a complex disease of epidemic proportions. In the United States, it accounts for more than 1 million hospitalizations annually,and heart failure represents the single greatest cost to the Centers for Medicaid and Medicare Studies. Half of the annual costs are estimated to be the result of hospitalization. Compared with other pathology, heart failure has a very high hospitalization rate, with 80% of emergency department ADHF patients being admitted. This high rate has resulted from the lack of successful management predictors available to the emergency physician and the lack of any disposition option other than hospitalization for the ADHF patient. The emergency department observation unit offers an alternative to hospitalization for patients with ADHF. Validated protocols have demonstrated that in ADHF, intensive short-term therapeutic, diagnostic, and educational protocols result in a marked improvement in hospitalization rates, while at the same time decreasing costs. New risk stratification data can aid in the identification of the appropriate candidate. The observation unit now represents a nonhospitalization disposition option for patients presenting to the emergency department with ADHF.viii CO
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PMID:Using the emergency department clinical decision unit for acute decompensated heart failure. 1627 26

Acute decompensated heart failure (ADHF) is a highly prevalent condition, with elevated short and longterm morbidity and mortality. Clinical deterioration is triggered by many factors that could promote minor myocardial damage (MMD), and the main tools for diagnosis are cardiac troponins T and I. The aim of this article is to review of the current knowledge about the prevalence and prognostic role of MMD in ADHF. Increased levels of troponins has been reported in up to half of patients admitted for ADHF, and they were associated with higher in-hospital incidence of refractory heart failure and death, as well as with poor longterm outcome. Moreover, MMD was an independent prognostic marker of events. The availability of MMD markers has changed the risk stratification in ADHF. Among the emerging approach applying this thought is the combined use with natriuretic peptides as marker of ventricular overload, which has improved the risk-stratification. The concept that an active process, either primary or secondary, has a prognostic implication during ADHF must be incorporated to the clinical practice.
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PMID:Importance of myocardial damage in acute decompensated heart failure: changing the paradigm from a passive to an active process. 1633 36

Acute decompensated heart failure is a growing public health care problem worldwide. The goals of treatment are immediate hemodynamic and symptomatic improvement followed by persistent follow-up with adherence to chronic heart failure guidelines. Controversies have centered around the best treatment options and avoidance of serious adverse events. This article highlights our current understanding of acute decompensated heart failure, discusses the controversy surrounding currently available new vasoactive treatments, and details future potential therapies.
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PMID:Management of acute decompensated heart failure: treatment, controversy, and future directions. 1686 79

Acute decompensated heart failure represents a heterogeneous group of disorders that typically present as dyspnea, edema and fatigue. Despite the high prevalence of this condition and its associated major morbidity and mortality, diagnosis can be difficult, and optimal treatment remains poorly defined. Identification of the acute triggers for the decompensation as well as noninvasive characterization of cardiac filling pressures and output is central to management. Diuretics, vasodilators, continuous positive airway pressure and inotropes can be used to alleviate symptoms. However, few agents currently available for the treatment of acute decompensated heart failure have been definitively shown in large prospective randomized clinical trials to provide meaningful improvements in intermediate-term clinical outcomes. Multiple novel therapies are being developed, but previous treatment failures indicate that progress in the management of acute decompensated heart failure is likely to be slow.
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PMID:Management of acute decompensated heart failure. 1763 58

Heart failure, a debilitating complex clinical syndrome, affects nearly 5 million people in the United States and presents a heavy socioeconomic burden. Neurohormonal abnormalities contribute to the pathophysiology of heart failure. Acute decompensated heart failure (ADHF) has emerged as a major health problem associated with poor prognosis, increased costs related to care, reduced quality of life, and frequent readmissions. Symptoms of ADHF are primarily related to congestion and/or low perfusion states. The use of biomakers such as B-natriuretic peptides is useful in distinguishing between cardiac and noncardiac causes of symptoms. Treatment for ADHF begins with identification and treatment of precipitating factors for acute decompensation. Initial goal of therapy is focused on symptom management followed by interventions that delay disease progression, reduce readmission, and prolong survival.
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PMID:Management of acute decompensated heart failure. 1735 51

Acute decompensated heart failure (ADHF) is an important milestone in the clinical course of heart failure (HF). It is an event associated with a significant deterioration in the prognosis of HF. Despite the progress that has been made in the development of new pharmacologic and nonpharmacologic therapy for HF, there is surprisingly limited advancement in the treatment of acute HF. There are currently no guidelines for the treatment of ADHF. This is a review of the current diagnostic evaluation and treatment of patients with ADHF.
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PMID:Acute decompensated heart failure: pathophysiology and treatment. 1769 45

Acute decompensated heart failure poses a complex clinical challenge for the health care community. Evolving concepts of the pathophysiology and lack of consensus on appropriate outcome measures for drug approval underlie some of the current controversies about nesiritide. We outline the major controversies from the viewpoint that nesiritide should continue to be used judiciously by following its package insert recommendations and the Heart Failure Society of America's 2006 Comprehensive Heart Failure Practice Guidelines.
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PMID:Controversy and conflict in the treatment of acute decompensated heart failure: nesiritide as evidence-based treatment. 1746 96


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