[Acute heart failure: clinical profiles and pathophysiology]

Area of Science:

• Cardiology
• Geriatrics
• Internal Medicine

Context:

• Acute heart failure (HF) is a leading diagnosis for elderly patients (>65 years) upon hospital discharge.
• HF presents a significant challenge due to its complex nature, varied pathophysiological mechanisms, and diverse clinical manifestations.
• High in-hospital mortality and substantial post-discharge mortality and rehospitalization rates underscore the severity of acute HF.

Purpose:

• To highlight the complexity of acute heart failure (HF) diagnosis and management.
• To emphasize the prognostic significance of different clinical scenarios in acute HF.
• To underscore the importance of identifying and treating underlying pathophysiological mechanisms in acute HF.

Summary:

• Acute heart failure (HF) is a prevalent condition in older adults, characterized by high mortality and rehospitalization rates.
• HF encompasses diverse presentations, including de novo vs. decompensated chronic HF, ischemia-related HF, and HF with varying blood pressure levels.
• Management strategies must address specific clinical scenarios and underlying causes like hydrosaline retention or comorbidities such as diabetes and renal insufficiency.

Impact:

• Recognizing varied clinical presentations and underlying causes of acute HF is essential for effective therapeutic strategies.
• Tailoring treatment to specific pathophysiological mechanisms and clinical scenarios can potentially improve outcomes for acute HF patients.
• A primary objective in acute HF management should be the identification and, where feasible, treatment of the root causes.