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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 (ADHF) continues to increase in prevalence and is associated with substantial mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than eight million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The increase in the prevalence and cost of HF is primarily the result of shifting demographics and a growing population. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that a growing number of studies began to address the management of ADHF. It is the intent of this review to update the clinician regarding the evaluation and optimal management of ADHF.
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PMID:Acute decompensated heart failure update. 2425 54

Acute decompensated heart failure may occur de novo, but it most often occurs as an exacerbation of underlying chronic heart failure. Hospitalization for heart failure is usually a harbinger of a chronic disease that will require long-term, ongoing medical management. Leaders in the field generally agree that repeated inpatient admissions for treatment reflect a failure of the health care delivery system to manage the disease optimally. Newer management strategies focus on ameliorating symptoms by optimizing the hemodynamics, restoring neurohormonal balance, and making frequent outpatient adjustments when needed.
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PMID:Managing acute decompensated heart failure. 2428 85

Acute decompensated heart failure is a common cause of hospitalisation. This is a period of vulnerability both in altered pathophysiology and also the potential for iatrogenesis due to therapeutic interventions. Renal dysfunction is often associated with heart failure and portends adverse outcomes. Identifying heart failure patients at risk of renal dysfunction is important in preventing progression to chronic kidney disease or worsening renal function, informing adjustment to medication management and potentially preventing adverse events. However, there is no working or consensus definition in international heart failure management guidelines for worsening renal function. In addition, there appears to be no concordance or adaptation of chronic kidney disease guidelines by heart failure guideline development groups for the monitoring of chronic kidney disease in heart failure. Our aim is to encourage the debate for an agreed definition given the prognostic impact of worsening renal function in heart failure. We present the case for the uptake of the Acute Kidney Injury Network criteria for acute kidney injury with some minor alterations. This has the potential to inform study design and meta-analysis thereby building the knowledgebase for guideline development. Definition consensus supports data element, clinical registry and electronic algorithm innovation as instruments for quality improvement and clinical research for better patient outcomes. In addition, we recommend all community managed heart failure patients have their baseline renal function classified and routinely monitored in accordance with established renal guidelines to help identify those at increased risk for worsening renal function or progression to chronic kidney disease.
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PMID:Worsening renal function in heart failure: the need for a consensus definition. 2480 Oct 76

Acute decompensated heart failure (ADHF) is the most common cause of cardiovascular hospitalization. The presentation is characterized by different clinical profiles due to various underlying causes, volume balance and tissue perfusion status. Currently, a variety of pharmacological therapies, including diuretics, beta-blockers, ACE-inhibitors, angiotensin receptor blockers and digoxin, are usually prescribed in order to treat chronic heart failure (HF) syndromes caused by left ventricular systolic dysfunction. Despite the large number of HF patients with frequent hospitalizations for decompensation, only a few studies have evaluated the management of oral chronic therapies in the clinical setting of ADHF. This article summarizes the information derived from the few published trials on this subject and a therapeutic approach is suggested with respect to the continuation, dose modification or suspension of oral medications.
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PMID:Management of oral chronic pharmacotherapy in patients hospitalized for acute decompensated heart failure. 2512 9

Acute decompensated heart failure is a significant source of morbidity and mortality in the USA. It is the most common reason for admission in the Medicare population and the greatest cause of hospital readmission in both medical and surgical patients. As many of these readmissions are considered preventable, providers and hospital systems are seeking novel strategies to reduce rehospitalization. Several specific interventions have been shown to decrease readmission for heart failure. However, these are typically narrow in scope, focusing on one aspect of patient care and providing a one-size-fits-all approach. We review the data and propose integrating some of these interventions into a comprehensive patient-centered model that is organized into six categories: quality of medical management, early reassessment, health literacy, neuropsychological status, financial means and functional status. By screening for deficiencies in each of these categories, providers and hospital systems can use resources more efficiently to make targeted interventions to improve health outcomes and mitigate readmissions.
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PMID:Hospital readmission in heart failure, a novel analysis of a longstanding problem. 2528 58

Biomarkers of cardiovascular diseases are indispensable tools for diagnosis and prognosis, and the use of biomarkers is now considered standard-of-care. New markers continue to be developed, but few prove to be substantially better than established markers. Heart failure (HF) risk stratification may be refined by the use of biomarkers for different pathobiological processes that established mortality risk factors do not directly reflect. Biomarkers that are currently available can provide information about at least seven pathobiological processes operative in HF, help to identify the specific processes involved in individual patients, and aid in constructing management plans. However, the additional prognostic information gained by any biomarker over a clinical risk model plus other biomarkers needs to be determined with adequate statistical tools. A major problem in selecting a biomarker profile is the proportional increase in economic burden; thus, the addition of any biomarker to a profile should be justified by adequate discrimination, calibration, reclassification, and likelihood analyses. This review assesses the value of multimarker strategies in both acutely decompensated (ADHF) and chronic HF. Most data on biomarkers have been derived from patient cohorts with chronic HF. However, risk prediction in patients admitted with ADHF remains a challenge. ADHF is not a single disease, it presents in various manners and different etiologies may underlie ADHF, which are reflected by different biomarkers. The optimal panel of markers, the change in these markers over time, and how these changes might help guide therapeutic interventions remain to be defined.
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PMID:Multiple biomarker strategies for risk stratification in heart failure. 2545 45

This review aims to discuss and summarize the evidence base for devices that have a role in monitoring patients with heart failure for the purpose of attempting to prevent heart failure-related admissions. Despite contemporary heart failure service provision, many patients continue to need acute admission for decompensation. There is a clinical need for a better strategy for predicting decompensation earlier so that appropriate therapeutic interventions can be commenced sooner in order to prevent the need for acute hospital admission. Between clinical assessment visits, the contemporary approach to management is based primarily on daily home monitoring of weight by patients; while this has proved useful, it falls short. For example, substantial weight gain was seen in only 20% of ADHF admission patients according to data collected in the TEN-HMS home telemonitoring study. Monitoring devices offer the possibility of tracking additional physiological or haemodynamic parameters that may allow for earlier detection and more accurate identification of patients at risk of acute decompensation.
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PMID:Role of Monitoring Devices in Preventing Heart Failure Admissions. 2604 64

Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure.
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PMID:Volume Overload in Heart Failure: An Evidence-Based Review of Strategies for Treatment and Prevention. 2618 43

Heart failure (HF) is an increasingly prevalent syndrome and a leading cause of both first hospitalization and readmissions. Strikingly, up to 25% of the patients are readmitted within 30 to 60-days, accounting for HF as the primary cause for readmission in the adult population. Given its poor prognosis, one could describe it as a "malignant condition". Acute decompensation is intrinsically related to increased right heart tele-diastolic pressures and often related to congestive symptoms. In-hospital strategies to adequately compensate and timely discharge patients are limited. Conversely, the fragile early postdischarge phase is a vulnerable period when one could potentially intervene cost-effectively to improve survival and to reduce morbidity. Promising transitional hospital-to-home programs may have a broader role in the near future, namely for selected higher risk patients. However, identifying patients at risk for hospital readmission has been challenging. Novel approaches, such as ferric carboxymaltose and valsartan/sacubitril, and reemerging drugs, particularly digoxin, may reduce hospitalizations. Despite this, optimizing the use of "older" therapies is still warranted. Right heart pressures monitoring may provide novel insights into promptly outpatient management. Unfortunately, randomized trials in the specific ADHF population are scarce. A novel paradigmatic approach is needed in order to suitably improve the currently poor prognosis of ADHF. Both improving survival and reducing hospitalizations are, therefore, primordial therapy goals. Lastly, no single drug has consistently proved to improve survival in HF with preserved ejection fraction (HFpEF); yet, some approaches may efficiently reduce hospitalizations. Awareness on HFpEF management beyond the failing heart is imperative.
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PMID:Acute decompensated heart failure (ADHF): A comprehensive contemporary review on preventing early readmissions and postdischarge death. 2759 46

Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients.
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PMID:Acute Decompensated Heart Failure: New Strategies for Improving Outcomes. 2844 33


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