Acute heart failure: patient management of a growing epidemic

Acute heart failure is a rapidly growing clinical problem in the United States. There are few randomized clinical trials to guide treatment; however, important observational data are now emerging from the Acute Decompensated Heart Failure National Registry regarding the demographics and treatment of these patients. Management consists largely of identification and treatment of precipitating factors, correction of comorbid conditions, and IV diuretics and vasodilators. Nitroprusside is a valuable treatment, but its use is usually restricted to patients in the intensive care unit who are undergoing hemodynamic monitoring. Nesiritide is being increasingly employed. Specialized strategies such as dialysis, continuous venous-venous hemodialysis, extra-corporeal membrane oxygenator, left ventricular assist device, and heart transplantation are employed in a small subset of patients. Although recovery is the rule, the in-hospital mortality for acute heart failure is high and the readmission rate is very high. Prevention of acute heart failure by avoiding factors known to precipitate decompensation remains the most cost-effective strategy.