Heart Failure Update: Inpatient Management

Acute decompensated heart failure (HF) is one of most common reasons for hospitalization among individuals older than 65 years. A thorough evaluation, including history, physical examination, and laboratory assessment, is required to optimize care of these patients. In uncertain cases, serum brain-type natriuretic peptide (BNP) or N-terminal proBNP level, stress testing, and/or invasive coronary angiography may be helpful in establishing the diagnosis. The hospital setting provides an opportunity to identify etiologies and stabilize the patient. The primary goal of inpatient HF therapy is systemic and pulmonary decongestion, achieved most effectively using intravenous diuretic therapy. Rate and rhythm control may be needed for patients with concurrent atrial fibrillation and, in American College of Cardiology/American Heart Association stage D HF, intravenous inotropes may become necessary. New pharmacologic or device therapies also are considered as a means of transitioning patients, especially those with severe disease, to the outpatient setting. Patients hospitalized for acute decompensated HF have high postdischarge mortality and rehospitalization rates and, thus, should be monitored carefully.