Document Detail


Current treatment options for early management in acute decompensated heart failure.
MedLine Citation:
PMID:  18629382     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute decompensated heart failure (ADHF) is a common syndrome that precedes over 100,000 hospitalizations in Canada per year (with length of stay in excess of six to eight days), making this the most costly disorder for patients older than 65 years of age. Over 85% of ADHF patients present with shortness of breath and exhibit evidence of volume overload. These findings may be variable in elderly patients, which complicates diagnosis. In fact, even in experienced centres, diagnostic accuracy is less than 80%. Despite advances in the treatment of chronic heart failure, meaningful improvements in outcomes associated with ADHF are very few. The basic assessment and treatments have not changed (early parenteral diuretics, electrocardiographic and oxygen saturation monitoring, supplemental oxygen administration). The introduction of measurement of natriuretic peptides in those in whom the diagnosis is uncertain may reduced the error rate by over 50%. The use of vasodilator therapy in the absence of cardiogenic shock can lead to earlier amelioration of symptoms, especially in those who do not respond to initial diuretics. Repeated monitoring of vital signs, body weight, electrolytes and creatinine levels is essential to minimize the risk of side effects of treatments. Noninvasive ventilation may reduce the need for endotracheal intubation in patients with severe ADHF and hypoxia at rest. Once the initial phase of heart failure treatment is completed, then the clinician should begin to focus on maximization of chronic heart failure therapy and discharge planning.
Authors:
Jonathan G Howlett
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  24 Suppl B     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-16     Completed Date:  2008-11-17     Revised Date:  2010-09-21    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  9B-14B     Citation Subset:  IM    
Affiliation:
Queen Elizabeth II Heart Function and Transplantation Clinic, Dalhousie University, Halifax, Nova Scotia. jonathan.howlett@cdha.nshealth.ca
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Canada
Cardiotonic Agents / therapeutic use
Combined Modality Therapy
Diuretics / therapeutic use
Drug Therapy, Combination*
Early Diagnosis
Female
Heart Failure / diagnosis,  mortality*,  therapy*
Humans
Male
Monitoring, Physiologic
Natriuretic Peptides / therapeutic use
Oxygen / therapeutic use*
Practice Guidelines as Topic
Respiration, Artificial / methods
Risk Assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Diuretics; 0/Natriuretic Peptides; 0/Vasodilator Agents; 7782-44-7/Oxygen
Comments/Corrections

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