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Inpatient Therapeutic Options

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Book cover Heart Failure

Part of the book series: Cardiovascular Medicine ((CVM))

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Abstract

Patients with acute dyspnea resulting from acute heart failure should be rapidly assessed and stabilized. First, patients should be put in a seated posture and, if necessary, supplemental oxygen and ventilatory support (noninvasive or invasive, see below) should be provided [1]. After that, therapeutic aims should be focused on the correction of hemodynamic and intravascular volume abnormalities. Therapy has to be tailored to the individual situation, however, diuretics are the mainstay of therapy in the acute setting. Early intravenous vasodilator therapy is important for selected patients with the need of targeting systemic vascular resistance and left ventricular overload. This includes patients with severe hypertension, acute mitral regurgitation, or acute aortic regurgitation. The patient’s hemodynamic and volume status determines how aggressive diuretic and vasodilator therapy has to be initiated. Acute heart failure therapy may be guided differentially in three stages of treatment: urgent/emergent care, hospitalization, and pre-discharge [2]. Therapies can be necessary to be used during any of these stages and are discussed in the following in detail. Monitoring and diagnostics in acute heart failure are discussed above.

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References

  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016:ehw128. https://doi.org/10.1093/eurheartj/ehw128.

    Article  Google Scholar 

  2. Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Vol 112, p 3958–3968. Presented at the Circulation, Lippincott Williams & Wilkins. https://doi.org/10.1161/CIRCULATIONAHA.105.590091.

    Article  Google Scholar 

  3. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797–805. https://doi.org/10.1056/NEJMoa1005419.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389–93. https://doi.org/10.1016/S0140-6736(97)08417-1.

    Article  CAS  PubMed  Google Scholar 

  5. Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF). Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287(12):1531–40.

    Google Scholar 

  6. Johnson W, Omland T, Hall C, Lucas C, Myking OL, Collins C, et al. Neurohormonal activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure. J Am Coll Cardiol. 2002;39(10):1623–9.

    Article  CAS  Google Scholar 

  7. Mullens W, Abrahams Z, Francis GS, Skouri HN, Starling RC, Young JB, et al. Sodium nitroprusside for advanced low-output heart failure. J Am Coll Cardiol. 2008;52(3):200–7. https://doi.org/10.1016/j.jacc.2008.02.083.

    Article  CAS  PubMed  Google Scholar 

  8. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola V-P, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725–36. https://doi.org/10.1093/eurheartj/ehl193.

    Article  PubMed  Google Scholar 

  9. Aaronson KD, Sackner-Bernstein J. Risk of death associated with nesiritide in patients with acutely decompensated heart failure. JAMA. 2006;296(12):1465–6. https://doi.org/10.1001/jama.296.12.1465.

    Article  CAS  PubMed  Google Scholar 

  10. Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med. 2005;142(7):510–24.

    Article  CAS  Google Scholar 

  11. Kociol RD, Hammill BG, Fonarow GC, Klaskala W, Mills RM, Hernandez AF, Curtis LH. Generalizability and longitudinal outcomes of a national heart failure clinical registry: comparison of Acute Decompensated Heart Failure National Registry (ADHERE) and non-ADHERE Medicare beneficiaries. Am Heart J. 2010;160(5):885–92. https://doi.org/10.1016/j.ahj.2010.07.020.

    Article  PubMed  Google Scholar 

  12. Cuffe MS, Califf RM, Adams KF, Benza R, Bourge R, Colucci WS, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287(12):1541–7.

    Article  CAS  Google Scholar 

  13. Felker GM, Benza RL, Chandler AB, Leimberger JD, Cuffe MS, Califf RM, et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41(6):997–1003.

    Article  CAS  Google Scholar 

  14. Teerlink JR. Overview of randomized clinical trials in acute heart failure syndromes. Am J Cardiol. 2005;96(6A):59G–67G. https://doi.org/10.1016/j.amjcard.2005.07.022.

    Article  CAS  PubMed  Google Scholar 

  15. Cleland JGF, Freemantle N, Coletta AP, Clark AL. Clinical trials update from the American Heart Association: REPAIR-AMI, ASTAMI, JELIS, MEGA, REVIVE-II, SURVIVE, and PROACTIVE. Eur J Heart Fail. 2006;8(1):105–10. https://doi.org/10.1016/j.ejheart.2005.12.003.

    Article  CAS  PubMed  Google Scholar 

  16. Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet. 2013;381(9860):29–39. https://doi.org/10.1016/S0140-6736(12)61855-8.

    Article  CAS  PubMed  Google Scholar 

  17. Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg Med J. 2008;25(4):205–9. https://doi.org/10.1136/emj.2007.050419.

    Article  CAS  PubMed  Google Scholar 

  18. Konstam MA, Gheorghiade M, Burnett JC, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297(12):1319–31. https://doi.org/10.1001/jama.297.12.1319.

    Article  CAS  PubMed  Google Scholar 

  19. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007;49(6):675–83. https://doi.org/10.1016/j.jacc.2006.07.073.

    Article  CAS  PubMed  Google Scholar 

  20. Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296–304. https://doi.org/10.1056/NEJMoa1210357.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Park JH, Balmain S, Berry C, Morton JJ, McMurray JJV. Potentially detrimental cardiovascular effects of oxygen in patients with chronic left ventricular systolic dysfunction. Heart. 2010;96(7):533–8. https://doi.org/10.1136/hrt.2009.175257.

    Article  PubMed  Google Scholar 

  22. Gray AJ, Goodacre S, Newby DE, Masson MA, Sampson F, Dixon S, et al. A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial. Health Technol Assess (Winchester, England). 2009;13(33):1–106. https://doi.org/10.3310/hta13330.

    Article  CAS  Google Scholar 

  23. Thiele H, Allam B, Chatellier G, Schuler G, Lafont A. Shock in acute myocardial infarction: the Cape Horn for trials? Eur Heart J. 2010;31(15):1828–35. https://doi.org/10.1093/eurheartj/ehq220.

    Article  PubMed  Google Scholar 

  24. Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96. https://doi.org/10.1056/NEJMoa1208410.

    Article  CAS  PubMed  Google Scholar 

  25. Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382(9905):1638–45. https://doi.org/10.1016/S0140-6736(13)61783-3.

    Article  PubMed  Google Scholar 

  26. Thiele H. Treatment of cardiogenic shock: what is proven? Dtsch Med Wochenschr. 2013;138(39):1960–5. https://doi.org/10.1055/s-0033-1349457.

    Article  CAS  PubMed  Google Scholar 

  27. Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic shock. Eur Heart J. 2015;36(20):1223–30. https://doi.org/10.1093/eurheartj/ehv051.

    Article  PubMed  Google Scholar 

  28. Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LSD, van Domburg RT, Serruys PW. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30(17):2102–8. https://doi.org/10.1093/eurheartj/ehp292.

    Article  PubMed  Google Scholar 

  29. Sheu J-J, Tsai T-H, Lee F-Y, Fang H-Y, Sun C-K, Leu S, et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med. 2010;38(9):1810–7. https://doi.org/10.1097/CCM.0b013e3181e8acf7.

    Article  CAS  PubMed  Google Scholar 

  30. Chen Y-S, Lin J-W, Yu H-Y, Ko W-J, Jerng J-S, Chang W-T, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372(9638):554–61. https://doi.org/10.1016/S0140-6736(08)60958-7.

    Article  PubMed  Google Scholar 

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Correspondence to Philip W. Raake .

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Kreusser, M.M., Raake, P.W. (2019). Inpatient Therapeutic Options. In: Feldman, D., Mohacsi, P. (eds) Heart Failure. Cardiovascular Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-98184-0_11

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  • DOI: https://doi.org/10.1007/978-3-319-98184-0_11

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