From the Guidelines
The treatment for acute heart failure in a hospitalized patient involves improving haemodynamics and organ perfusion, restoring oxygenation, alleviating symptoms, limiting cardiac and renal damage, and preventing thrombo-embolism.
Key Treatment Goals
- Immediate treatment in the emergency department, intensive care unit, or coronary care unit focuses on improving haemodynamics and organ perfusion, restoring oxygenation, alleviating symptoms, and limiting cardiac and renal damage 1.
- Intermediate treatment involves identifying the aetiology and relevant co-morbidities, titrating therapy to control symptoms and congestion, and optimizing blood pressure 1.
- Pre-discharge and long-term management includes developing a care plan, enrolling in a disease management programme, educating the patient, and initiating lifestyle adjustments to prevent early readmission and improve symptoms, quality of life, and survival 1.
Treatment Strategies
- Diuretics: Loop diuretics, such as furosemide, are commonly used to treat fluid overload and congestion in acute heart failure 1.
- Vasodilators: Intravenous nitroglycerin, nitroprusside, or nesiritide can be beneficial in patients with severely symptomatic fluid overload and no systemic hypotension 1.
- Inotropic agents: May be used in patients with low cardiac output and evidence of end-organ hypoperfusion, but with caution due to potential adverse effects 1.
- Beta-blockers: Should be initiated at a low dose and only in stable patients after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents 1.
- Mechanical fluid removal: Ultrafiltration, haemofiltration, or haemodialysis may be considered in patients with refractory congestion 1.
- Device therapy: May be considered in appropriate patients, such as those with severe left ventricular dysfunction or recurrent hospitalizations 1.
Monitoring and Follow-up
- Close monitoring of the patient's clinical status, including vital signs, oxygen saturation, and renal function, is essential to guide treatment and adjust therapy as needed 1.
- Post-discharge systems of care should be used to facilitate the transition to effective outpatient care and prevent early readmission 1.
From the Research
Treatment Overview
The treatment for acute heart failure in a hospitalized patient involves several aspects, including:
- Diagnosis and prognostication using biomarker evaluation and noninvasive assessment of fluid status 2
- Decongestive strategies, such as pharmaceutical options and ultrafiltration for refractory hypervolemia 2, 3
- Vasoactive therapy to augment cardiac function, although its efficacy is limited 2
- Goal-directed medical therapy, including quadruple therapy with angiotensin receptor-neprilysin inhibitors, mineral receptor antagonists, sodium glucose type 2 (SGLT-2) inhibitors, and beta blockers 2, 4
Pharmacological Treatment
Pharmacological treatment options for acute heart failure include:
- Intravenous loop diuretics, either alone or in combination with a vasodilator, for patients with volume overload 3
- Inotropic agents, limited to patients with low-output syndrome and significant hypotension 3
- SGLT2 inhibitors and diuretics as first-line treatment for patients with heart failure with preserved ejection fraction or mildly reduced ejection fraction 4
Patient-Specific Considerations
Treatment should be tailored to each patient's clinical situation, cardiopulmonary condition, and geriatric assessment, particularly in elderly patients 5 Palliative care should be considered in some cases to avoid unnecessary diagnostics and/or treatments 5 Close ambulatory monitoring, virtual visits, and rehabilitation are essential for preventing heart failure rehospitalization and mortality 2