2006 Laennec Clinician/Educator Lecture—The Contemporary Management of Patients Admitted to Hospital With Acute Decompensated Heart Failure

Abstract

René Laénnäc was an adolescent at the time of the French Revolution and went on to a career of lasting importance in the history of medicine. Among his many accomplishments was the invention of the stethoscope, but as with many new ideas, there was much early skepticism. Eventually it became widely accepted. In today’s world of high-tech medicine, some would opine that the usefulness of the stethoscope is again declining. Of the many cardiological conditions that we treat on a day-to-day basis, heart failure is one where the stethoscope is still quite useful. Heart failure remains a clinical diagnosis, requiring that the physician actually extract a history and examine the patient at the bedside. However, the treatment of acute decompensated heart failure has changed dramatically over the years, even though advances in treatment have been hampered to some extent by the lack of randomized clinical trials. Management of these patients can be extremely difficult, particularly when complicated by resistance to loop diuretics, refractory edema, hyponatremia, and oliguria. Strategies to date have primarily depended on previous observational studies and include the use of diuretics, vasodilators, inotropic agents for selected patients, ultrafiltration, and occasionally dialysis. Although there are both European and US guidelines for the treatment of acute heart failure, we are in need of further randomized controlled trials to guide us through the maze of therapeutic options. Future considerations should include an understanding of how the syndrome develops and how it can be prevented in its early stages.