What is the treatment for Acute Congestive Heart Failure (CHF)?

From the Guidelines

Acute congestive heart failure treatment should prioritize decongestive therapies, including the combination of loop diuretics, and rapid implementation of guideline-directed oral medical therapies (GDMT) for HF, as highlighted in the most recent study 1. The initial approach to congestion management involves i.v. diuretics, such as furosemide, with the addition of vasodilators for dyspnoea relief if blood pressure allows, as recommended by the European Society of Cardiology 1. Key considerations in the treatment of acute congestive heart failure include:

• Decongestive therapies: loop diuretics, such as furosemide, should be used to reduce fluid overload, with the dose limited to the smallest amount to provide adequate clinical effect and modified according to previous renal function and previous dose of diuretics 1.
• Vasodilators: should be used to decrease preload and improve cardiac output, if blood pressure allows 1.
• Guideline-directed oral medical therapies (GDMT) for HF: should be initiated rapidly, including beta-blockers, renin-angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRAs) 1.
• Sodium-glucose co-transporter 2 inhibitors (SGLT2i): should be considered as part of the therapeutic arsenal for AHF patients, as their major role is no longer debatable 1.
• Non-pharmacological interventions: include sodium restriction, fluid restriction, daily weight monitoring, and elevation of the head of the bed to improve breathing, as well as patient education on expected benefits, potential adverse effects, and the importance of reporting deterioration 1. It is essential to continuously monitor vital signs, urine output, electrolytes, and renal function during treatment, and to transition patients to chronic heart failure management with appropriate medication adjustments and lifestyle modifications to prevent recurrence, as emphasized in the European Journal of Heart Failure 1.

From the FDA Drug Label

Milrinone Lactate Injection is indicated for the short-term intravenous treatment of patients with acute decompensated heart failure. Nitroglycerin Injection is indicated for control of congestive heart failure in the setting of acute myocardial infarction. Dobutamine Injection, USP is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures.

The treatment for acute congestive heart failure may include:

• Milrinone for short-term intravenous treatment of patients with acute decompensated heart failure 2.
• Nitroglycerin (IV) for control of congestive heart failure in the setting of acute myocardial infarction 3.
• Dobutamine for short-term inotropic support in patients with cardiac decompensation due to depressed contractility 4. Key considerations include close monitoring with electrocardiographic equipment and availability of immediate treatment for potential cardiac events.

From the Research

Acute Congestive Heart Failure Treatment

• The treatment of acute congestive heart failure (CHF) involves reducing preload and afterload of the heart muscle, which can be achieved with the use of nitroglycerin and its derivatives 5.
• Nitroglycerin is effective in reducing mean pulmonary artery and wedge pressures, as well as pulmonary and peripheral vascular resistances, leading to an increase in cardiac index and a decrease in patients' complaints 5.
• In the prehospital setting, the management of acute CHF entails reduction of left ventricular (LV) preload, reduction of LV afterload, ventilatory support, inotropic support as needed, and identification and treatment of other underlying factors contributing to elevated LV filling pressures 6.
• Nitroglycerin is the most applicable and effective agent for field treatment of acute CHF, while diuretics and morphine should be used with caution due to higher risks, especially in misdiagnosed patients 6.
• The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure, including those with acute CHF 7.
• The guideline presents an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests, and includes updated recommendations based on contemporary evidence 7.