Acutely decompensated versus acute heart failure: two different entities

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Heart failure (HF) is currently classified into chronic HF (CHF) and acute HF (AHF).
• Acute HF is further subdivided into acutely decompensated chronic HF (ADCHF) and de novo AHF, despite fundamental pathophysiological differences.
• The natural illness trajectory of HF mirrors other chronic organ failures, involving gradual decline with acute episodes and partial recovery.

Purpose of the Study:

• To propose a paradigm shift in HF classification based on pathophysiological differences.
• To rename ADCHF as CHF exacerbation (CHFE) to align with established terminology.
• To redefine AHF to encompass only acute de novo HF.

Main Methods:

• Conceptual analysis of HF pathophysiology and clinical trajectories.
• Comparison with terminology used in other chronic organ diseases (e.g., COPD).
• Discussion of clinical implications for management strategies.

Main Results:

• ADCHF is proposed to be reclassified as CHF exacerbation (CHFE), reflecting its nature as part of chronic CHF progression.
• De novo AHF should be exclusively defined as rapid-onset new HF requiring urgent care.
• The proposed classification highlights distinct pathophysiological pathways and clinical trajectories.

Conclusions:

• Renaming ADCHF to CHFE aligns terminology with other chronic diseases and emphasizes management of the underlying chronic condition.
• Defining AHF strictly as de novo HF necessitates distinct acute care interventions.
• This reclassification aims to optimize management strategies, focusing on prevention for CHFE and acute injury limitation for AHF.