Acute decompensated heart failure: Systolic and diastolic

Abstract

Heart failure is a chronic disease characterized in part by intermittent exacerbations of worsening symptoms that increase in frequency with disease progression. Despite a trend towards reduced heart failure hospitalization over the last decade, heart failure remains the most common cause of hospitalization in the Medicare population. Hospitalization for worsening symptoms is a sentinel event that identifies heart failure patients at high risk for subsequent morbidity and mortality. Initial assessment should include confirmation of the diagnosis (recognizing that patient may present with atypical signs and symptoms), measurement of left ventricular function with appropriate imaging procedures, identification of precipitating factors, clinical assessment of the hemodynamic status based on physical findings of congestion and tissue perfusion, and formulation of an individualized treatment plan. Decongestion therapy with intravenous loop diuretics is the most common therapeutic intervention with similar treatment approaches in patients with preserved or reduced ejection fraction. The cardiology consultant should also assess prognosis based on clinical findings and biomarkers and make recommendations for palliative care options in patients with poor prognosis who are not eligible for advanced therapies such as left ventricular assist device or cardiac transplantation. The cardiology consultant should also arrange appropriate transition of care at discharge with plans for post-discharge optimization of medical and device therapy and for high-risk patients, referral to a heart failure disease management program.