Treatment goals and discharge criteria for hospitalized patients with acute heart failure

Abstract

Acute heart failure (AHF) represents a potentially fatal disease that needs immediate hospital care. In-hospital management can be divided into three consecutive phases: an early phase of intensive management of symptoms, an intermediate phase of stabilization and transition from intravenous to oral medication, and a late phase of discharge and outpatient management. However, despite its life-threatening features (increased mortality and readmission rates), many treatment decisions are opinion based and only few are evidence based. The present paper describes in-hospital treating modalities and attempts to provide clinical and laboratory criteria for patient evaluation that will help doctors determine readiness and safety of discharge. In addition, it highlights some unresolved issues that need to be addressed by future research.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/ 5608938/Activity.aspx

Investigating the effect of an online enhanced care program on the emotional and physical wellbeing of patients discharged from hospital with acute decompensated heart failure: Study protocol for a randomised controlled trial: Enhanced care program for heart failure

“…However, the type of discharge support currently provided for patients with acute HF tends to focus on physical, rather than emotional, aspects of care and is inconsistent across hospitals and healthcare providers. 41 Most commonly, written information is provided but patient utilisation and comprehension of these materials is not well understood.…”

Galectin-3 changes from admission to discharge and its prognostic value for in-hospital mortality in heart failure: A prospective observational study

“…Patients were considered eligible for discharge based on the following criteria: their clinical symptoms, such as dyspnea, edema, and palpitations, had been alleviated and their blood pressure was stable (systolic blood pressure > 90 mm Hg) with a SpO2 level of >95% and no signs of orthostatic hypotension; had not received any vasopressors for at least 24 hours prior to discharge, had stable renal function, and normal urine volume, with or without the use of oral diuretics; BNP reduced by at least 30% compared to admission; had received an optimized medical treatment plan, with appropriate drug dosages tailored to each patient based on the heart failure treatment protocol, including renin-angiotensin-aldosterone system inhibitors, beta-blockers, and diuretics (including loop diuretics and potassium-sparing diuretics) as well as SGLT2 inhibitors. [ 13 ]…”

A narrative review on the management of Acute Heart Failure in Emergency Medicine Department

“…Though transthoracic echocardiography does not commonly exist in emergency medicine department, focused heart ultrasound within the emergency medicine department could be applied as an effective point-of-care testing tool for assessing left ventricular dysfunction. 21 Visual assessment of decreased normal left ventricular ejection fraction could be done through evaluating ventricular septum inward movement and left ventricle inferior wall pending systole and also through observing the excursion degree of the anterior leaflet of the bicuspid valve in the direction of the ventricular septum when the heart refills with blood after the emptying during systole. These evaluations are associated with quantitative EF echocardiographic measurements.…”