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Herz

, Volume 44, Issue 1, pp 53–55 | Cite as

Acute heart failure

An unmet medical need
  • A. G. Rigopoulos
  • C. Bakogiannis
  • R. de Vecchis
  • S. Sakellaropoulos
  • M. Ali
  • M. Teren
  • M. Matiakis
  • C. Tschoepe
  • M. NoutsiasEmail author
Review articles

Abstract

Despite recent advances in the management of heart failure with reduced ejection fraction (HFrEF), the burden of acute heart failure (AHF) remains significant with a high morbidity and mortality that has not been improved by any treatment modality. A meta-analysis summarized the study results on the effects of tolvaptan on AHF, which failed to demonstrate an improvement in short-term and long-term mortality, length of hospital stay and reduced frequency of worsening heart failure (WHF). Similar trial results were also reported in other AHF studies, such as the ASCEND-HF and the RELAX-AHF-2 trials. In view of these inconclusive studies it is evident that improving the prognosis of AHF patients remains an unmet medical need. Further efforts should focus on organ damage protection, individualized treatment, patient benefits and standardized management programs, including immediate identification and management of cardiogenic shock and establishment of HF networks for close monitoring of AHF patients.

Keywords

Prognosis Tolvaptan Treatment Left ventricular assist devices Meta-analysis 

Abbreviations

AHF

Acute heart failure

HF

Heart failure

HFrEF

Heart failure with reduced ejection fraction

IABP

Intra-aortic balloon pump

LVAD

Left ventricular assist devices

LVEF

Left ventricular ejection fraction

MCS

Mechanical circulatory support

WHF

Worsening heart failure

Akutes Herzversagen

Ein unerfüllter medizinischer Bedarf

Zusammenfassung

Trotz jüngster Fortschritte im Management der Herzinsuffizienz mit reduzierter Ejektionsfraktion (HFrEF) bleibt die Belastung des akuten Herzversagens („acute heart failure“, AHF) mit hoher Morbidität und Mortalität signifikant und konnte bisher durch kein Behandlungsverfahren verbessert werden. Eine Metaanalyse fasste die Studienergebnisse zu den Auswirkungen von Tolvaptan auf AHF zusammen, das keine Verbesserung in Kurzzeit- und Langzeitmortalität, Hospitalisationsdauer und reduzierter Häufigkeit einer Verschlimmerung der Herzinsuffizienz („worsening heart failure“, WHF) zeigen konnte. Ähnliche Ergebnisse wurden auch in anderen AHF-Studien berichtet, wie z. B. der ACENT-HF- und der RELAX-AHF-2-Studie. In Anbetracht dieser nicht eindeutigen Studienlage stellt die Verbesserung der Prognose von AHF-Patienten offensichtlich einen unerfüllten medizinischen Bedarf dar. Zukünftige Bemühungen sollten auf den Schutz vor Organschäden, die individuelle Behandlung, den Nutzen für die Patienten sowie standardisierte Management-Programme fokussieren, einschließlich der sofortigen Identifizierung und des Managements eines kardiogenen Schocks sowie der Einrichtung von Herzinsuffizienz-Netzwerken für ein engmaschiges Monitoring von AHF-Patienten.

Schlüsselwörter

Prognose Tolvaptan Behandlung Linksventrikuläre Assist-Devices Metaanalyse 

Notes

Compliance with ethical guidelines

Conflict of interests

A.G. Rigopoulos, R. de Vecchis, S. Sakellaropoulos, M. Ali, M. Teren and M. Matiakis declare that they have no competing interests. C. Bakogiannis was employed by Novartis from August 2013 to July 2015. M. Noutsias received grants from the Deutsche Forschungsgemeinschaft (DFG) through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19) (TP B2) and from the University Hospital Gießen and Marburg Foundation Grant “T cell functionality” (UKGM 10/2009). He was consultant to the Institute for Cardiac Diagnosis and Therapy (IKDT, Berlin) from June 2004 to June 2008, and received fees for presentations and/or participation in advisory boards from AstraZeneca, Bayer, Fresenius, Miltenyi Biotech, Novartis, Pfizer and Zoll and is the local principal investigator (p. i.) of the trials RELAX-AHF-2, TRUE-HF and TRANSITION trials at the University Hospital Jena. C. Tschoepe received a grant by the DFG (SFB TR19 TP B5 and Z3).

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Department of Internal Medicine III – Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital HalleHalle (Saale)Germany
  2. 2.3rd Department of Cardiology, Ippokrateio HospitalAristotle University of ThessalonikiThessalonikiGreece
  3. 3.Cardiology UnitPresidio Sanitario Intermedio, “Elena d’Aosta”NapoliItaly
  4. 4.Department of CardiologyAsklepios Harzklinik GoslarGoslarGermany
  5. 5.Department of CardiologyCharité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
  6. 6.Deutsches Zentrum für Herz Kreislaufforschung (DZHK)—Standort BerlinCharité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
  7. 7.Berlin Center for Regenerative Therapies (BCRT)Campus Virchow Klinikum (CVK)BerlinGermany

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