Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology

Nieminen, Markku S.; Priori, Silvia G.; García, María Ángeles Alonso; Budaj, Andrzej; Burgos, Enrique Fernández; Lekakis, John; Mazzotta, Gianfranco; Smiseth, Otto A.; Dickstein, Kenneth; Crespo‐Leiro, María G.; Ferrari, Roberto

doi:10.1093/eurheartj/ehi044

Cited by 1,014 publications

(119 citation statements)

References 214 publications

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“…We analysed the data of 193 patients after excluding those with sampling error ( n = 4). The European Society of Cardiology definitions were used to classify APE and acute decompensated heart failure (ADHF) 7, 8. APE was defined as the acute onset of dyspnoea within the preceding 6 h and radiographic alveolar oedema 9.…”

Section: Methodsmentioning

confidence: 99%

Hypercapnia in patients with acute heart failure

et al. 2015

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AimsNon‐invasive positive pressure ventilation rapidly improves the symptoms of acute heart failure (AHF). A portion of patients, however, are forced to be intubated even though intubation is associated with serious complications, and hypercapnia is often observed in AHF requiring intubation. The purpose of this study is to examine the clinical profile and management of hypercapnia in AHF patients.Methods and resultsWe examined the arterial blood gas analysis in 193 consecutive AHF patients (73 ± 12 years, 61% men) at admission. Many patients (n = 129, 66.8%) had already been treated with oxygen by the ambulance staff. Hypercapnia (PaCO2 at admission >45 mmHg) and hypocapnia (PaCO2 < 35 mmHg) were observed in 33.7% and 32.6%, respectively. Whereas 16 (24.6%) hypercapnic patients were intubated, there were only one (1.5%) normocapnic and no hypocapnic patients intubated. Patients with hypercapnia are more likely to be in the New York Heart Association Class IV (96.9% vs. 78.9%, P < 0.001), to have acute onset within 6 h (50.8% vs. 25.0%, P < 0.001), and to have radiographic pulmonary oedema (84.6% vs. 57.8%, P < 0.001) than those with hypo‐normocapnia. Hypercapnia was more frequent in patients with acute cardiogenic pulmonary oedema than in those with acute decompensated heart failure (51.9% vs. 23.6%, P < 0.001). At discharge, hypercapnia was observed in 17.8% of patients who were hypercapnic at admission.ConclusionHypercapnia emerged in AHF acutely and transiently, was associated with immediate airway intervention, and was possibly involved in the pathophysiology of acute pulmonary oedema. Patients with acute onset dyspnoea should have their respiratory status carefully managed. These pathophysiological findings are expected to be utilized in treating or preventing AHF.

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Section: Methodsmentioning

confidence: 99%

Hypercapnia in patients with acute heart failure

et al. 2015

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“…However, to our knowledge, there are no studies using goal-directed therapy in advanced heart failure patients to improve morbi-mortality. 4 The aim of this pilot study was to examine the safety and feasibility of an early, goal-directed therapy in patients with advanced heart failure, signs of LCOS, and renal dysfunction.…”

Section: Treatment Protocolmentioning

confidence: 99%

Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Bastos¹,

Ferri²,

Lima³

et al. 2016

Medical Express

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OBJECTIVES:Acute heart failure is associated with low cardiac output syndrome and renal dysfunction. However, it is not known whether a goal-directed protocol guided by tightly controlled hemodynamic variables, including pulmonary artery catheter, will safely improve clinical renal dysfunction markers in these patients when compared to a less invasive approach. METHODS: Pilot, randomized clinical trial aimed at patients with known heart failure, low cardiac output syndrome and renal dysfunction with less than 48 hours from onset. We randomized two groups: (a) goal-directed therapy monitored with pulmonary artery catheter and (b) conventional therapy with central venous catheter. Hemodynamic parameters, venous oxygen saturation, serum lactate, fluid repositions and vasoactive drugs were compared considering renal function improvement after 72 hours as the primary study endpoint. We included 15 goal-directed therapy and 16 conventional therapy patients. The study has assessed patients on baseline looking for significant improvement at 72 hours of the following parameters in the goal-directed therapy and conventional therapy groups: urine output, serum creatinine, venous oxygen saturation and serum lactate. RESULTS: Baseline characteristics were similar in both groups. In the first 24 hours there was a lower volume of fluid reposition in the goal-directed therapy group, although 72 hours later such reposition was equivalent. The use of inotropic agents was similar between groups. There was an improvement to the renal function and the hemodynamic parameter in both study groups. CONCLUSIONS: The option for the protocol with pulmonary artery catheter setting is justified only if there is clinical evidence of serious pulmonary congestion associated to low peripheral perfusion.

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“…Patients with acute decompensated heart failure may have either low, normal or high cardiac output, mildly elevated end-diastolic pressure, or mildly increased total peripheral resistance. Patients with pulmonary edema usually have a low cardiac volume, elevated end-diastolic pressure and increased total peripheral resistance [5, 6]. …”

Section: Pathophysiologymentioning

confidence: 99%

Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

Hodt

Steine²,

Atar³

2006

Cardiology

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Background: The traditional medical treatment of acute heart failure (AHF) has remained unchanged for many years. It has been based on oxygen supplementation and mechanical ventilatory support as well as the administration of morphine, diuretics, nitrates and inotropic agents. In 2005 the European Society of Cardiology (ESC) published new guidelines on the diagnosis and treatment of AHF. Also, new therapies have been introduced recently, giving rise to changes in therapeutic concepts. Material/Method: Based on these new guidelines and recent studies selected from the literature we here describe the new ESC classification of AHF including its epidemiology and pathophysiology. We further present a state-of-the-art status of the choices of medical treatment for patients with acute decompensated heart failure and pulmonary edema. Results: Mechanical ventilatory support reduces the number of patients who require endotracheal intubation.Nitrates in dosages higher than employed today appear to be beneficiary to patients with pulmonary congestion, probably because of the pronounced afterload-reducing effect. Nesiritide, a synthetic brain natriuretic peptide, has shown better hemodynamic effects than common nitrate dosages in patients with congestive heart failure. Tezosentan, an endothelin antagonist, was tested in the biggest AHF trial ever, which, however, was terminated prematurely because it was futile to proceed given the endpoints dyspnea and death. The β₁-adrenergic drug dobutamine and the phosphodiestherase inhibitor milrinone are associated with increased mortality in patients with pronounced chronic and acute congestive heart failure. Levosimendan, a new inotropic drug, has shown lower mortality compared to dobutamine in patients with acute congestive heart failure. Conclusion: New concepts have finally emerged, including the application of old drugs such as nitrates in new (i.e., higher) dosages, as well as the novel compound levosimendan, recommended for patients with AHF and hypoperfused organs. The new ESC classification of AHF provides a valuable and long-awaited guideline to diagnose and treat this severe condition.

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Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology

Cited by 1,014 publications

References 214 publications

Hypercapnia in patients with acute heart failure

Hypercapnia in patients with acute heart failure

Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

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