From the Guidelines
Heart failure is considered decompensated when a patient with established heart failure experiences a worsening of symptoms that typically requires hospitalization or urgent medical attention, as defined by the 2013 ACCF/AHA guideline for the management of heart failure 1. This occurs when the heart can no longer maintain adequate cardiac output to meet the body's needs despite compensatory mechanisms. Signs of decompensation include:
- Increased shortness of breath (especially at rest or with minimal exertion)
- Worsening peripheral edema
- Rapid weight gain (typically 2-3 pounds in a day or 5 pounds in a week)
- Increased fatigue
- Orthopnea requiring more pillows to sleep
- Paroxysmal nocturnal dyspnea
- New or worsening pulmonary congestion on examination
- Jugular venous distention
- Decreased exercise tolerance Decompensation may be triggered by factors such as:
- Medication non-adherence
- Dietary indiscretion (excessive sodium intake)
- Infection
- Arrhythmias
- Myocardial ischemia
- Uncontrolled hypertension
- Progression of the underlying heart disease, as outlined in the 2013 ACCF/AHA guideline for the management of heart failure 1 and supported by the European Society of Cardiology's executive summary of the guidelines on the diagnosis and treatment of acute heart failure 1. The physiological basis involves the heart's inability to maintain forward flow, leading to fluid backup in the lungs and/or peripheral tissues, activation of neurohormonal systems, and further cardiac strain. Prompt recognition and treatment of decompensated heart failure is essential to prevent further deterioration and reduce morbidity and mortality, as emphasized in the clinical policy for the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes 1.
From the Research
Definition of Decompensated Heart Failure
Heart failure can be considered decompensated when the patient experiences a sudden worsening of symptoms, such as:
- Shortness of breath
- Dyspnea on exertion
- Increasing lower extremity edema
- Worsening fatigue These symptoms can be caused by various factors, including:
- Medication and diet noncompliance
- Arrhythmias
- Deterioration in renal function
- Poorly controlled hypertension
- Myocardial infarction
- Infections 2, 3
Identification of Decompensated Heart Failure
Decompensated heart failure can be identified by the presence of signs and symptoms of fluid overload or low cardiac output, such as:
- Elevated blood urea nitrogen (BUN)
- Decreased sodium
- Decreased hemoglobin
- History of percutaneous coronary intervention (PCI)
- Increased age
- Lower systolic blood pressure
- New York Heart Association class IV symptoms 4
Prevalence and Severity of Symptoms
Studies have shown that patients with acute decompensated heart failure often experience severe symptoms, including:
- Pain
- Tiredness
- Shortness of breath
- Decreased well-being These symptoms can have a significant impact on the patient's quality of life and require prompt medical attention 5
Causes of Decompensation
The causes of decompensation of chronic congestive heart failure can be attributed to various factors, including:
- Insufficient compliance with medication and diet
- Uncontrolled hypertension
- Insufficient diuretic therapy
- Treatment with negative inotropic drugs
- Acute rhythm disturbances
- Acute myocardial infarction or unstable angina pectoris
- Infections 6