Treatment of acute heart failure in the emergency department

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.

Keywords::

• acute heart failure
• classification
• emergency department
• heart failure
• injury
• phenotyping
• multimorbidity
• outcomes

Financial & competing interests disclosure

PS Pang has consulted for Novartis, Otsuka, Trevena, SpringLeafTx, BG Medicine; received Honoraria from Alere, Momentum Research, Nile Therapeutics, MyLife, Palatin Technologies in the last year. PS Pang has also received research Support from Abbott, Alere; received honoraria from the Society of Cardiovascular Patient Care, the American College of Cardiology Foundation, and is a KL2 Scholar. PS Pang was supported by the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH) though Grant Number KL2 RR025740-05. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. P Levy is or has been within the past year, a consultant for: Novartis, Trevena, The Medicines Company, Cornerstone Therapeutics, Astra Zeneca, Boerhinger Ingelheim. Within the past 12 months, P Levy has also received honoraria from the Society of Cardiovascular Patient Care. P Levy is currently supported by the National Institute on Minority Health and Health Disparities (NIMHD) through grant number R01 MD005849. S Shah has received research grants from NIH/NHLBI (R01 HL107577), American Heart Association and Gilead Sciences. S Shah has consulted for Bayer, Bristol Squib-Myers and received honoraria from Pulmonary Hypertension Association, United Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Outcomes after hospitalization from acute heart failure (AHF) remain poor, despite advances in cardiovascular management. The burden of AHF will likely increase, given the aging of the population and improved survival from other cardiovascular conditions.

• • There are no AHF therapies that are proven to reduce hospitalization or decrease mortality. This is evident from the lack of ‘highest’ level evidence recommendations from guidelines.

• • New insights, however, have been learned from large registries and clinical trials, especially with regard to prognosis and strategies of care.

• • In the emergency department, we recommend classifying patients using systolic blood pressure to help tailor therapy. There remains an unmet need to improve outcomes for AHF patients. Bold and novel hypotheses have been proposed to decrease the burden of AHF.

Notes