Hospitalized patients with acute decompensated heart failure: Recognition, risk stratification, and treatment review

Abstract

Acute decompensated heart failure (ADHF) has emerged as a major healthcare problem. It causes approximately 3% of all hospitalizations in the United States, with the direct medical cost of these hospitalizations estimated at $18.8 billion per year. Early recognition, risk stratification, and evidence-based treatment are crucial in reducing the morbidity, mortality, and costs associated with this disorder. Classic signs and symptoms of ADHF, such as rales, dyspnea, and peripheral edema, may be absent at hospital presentation and, even when present, are not specific to this disorder. As a result, serum B-type natriuretic peptide level is now used to rapidly and accurately detect ADHF. Multivariate analyses have identified renal dysfunction, hypotension, advanced age, hyponatremia, and comorbidities as significant and independent mortality risk factors. Based on these factors, mortality risk can be stratified from very low to very high using published algorithms that have been validated in independent populations. Evidence-based guidelines for the treatment of ADHF are available from both the European Society of Cardiology and the Heart Failure Society of America. In general, an intravenous loop diuretic, either alone or in combination with a vasodilator, is recommended as initial therapy in patients with volume overload, depending on the patient's clinical status. Use of inotropic agents should be limited to the small subset of patients with low-output syndrome and significant hypotension. In any event, frequent monitoring of clinical response is essential, with subsequent therapy determined by this response. Finally, focused patient education during hospitalization may help reduce readmissions for ADHF. Journal of Hospital Medicine 2008;3(Suppl 6):S16-S24. V

Nurses' knowledge and practice regarding implantable cardiac devices in Egypt

“…The result of that study showed that there was change among nurses in assisting patients to assume the role of being their own most important health-care manager and concluded that nurses should be educated in effective management of patients with implantable cardiac devices (Anushk, 2011). Amin ( 2008) carried out a study on the effectiveness of teaching programmes on nursing care of the results revealed that nurses' knowledge post test was high compared to pre test and concluded that patients are the beneficiaries of professional, competent nursing care provided by teaching programmes.…”

Malnutrition as Assessed by Nutritional Risk Index is Associated with Worse Outcome in Patients Admitted with Acute Decompensated Heart Failure: An ACAP-HF Data Analysis

“…22 Chronic heart failure (CHF) is increasingly recognized as a chronic multi-system disease with multiple co-morbidities such as anemia, insulin resistance, autonomic dysfunction, or cardiac cachexia. 23 Despite the fact that heart failure patients are more prone to experience malnutrition either due to symptomatic anorexia during an episode of ADHF, 23 early satiety and ascites, pharmacological agents, 24 psychological factors 25 or catabolic/anabolic imbalance, 26 the data regarding clinical significance of malnutrition in heart failure patients remain limited.…”

Single baseline serum creatinine measurements predict mortality in critically ill patients hospitalized for acute heart failure

“…Epidemiological data including data from larger cohorts of patients with CHF demonstrate that CKD may be present in up to 50% of affected patients . In addition, it seems pivotal to note that estimation of acute‐on‐chronic renal dysfunction in this specific cohort may be regarded especially difficult.…”

“…Epidemiological data including data from larger cohorts of patients with CHF demonstrate that CKD may be present in up to 50% of affected patients. 7,17,22,[33][34][35] In addition, it seems pivotal to note that estimation of acute-on-chronic renal dysfunction in this specific cohort may be regarded especially difficult. Nevertheless, although we aimed to investigate the effect of initial eGFR on long-term outcomes, we cannot fully elucidate the degree of CKD in the cohort under investigation.…”