Acute Decompensated Cardiac Failure

Abstract

Heart failure (HF) is a serious condition affecting an estimated two million Americans and is a common reason for hospitalization. The prognosis of patients admitted to hospital with HF is poor with up to 64 % being re-admitted within the first 90 days after discharge and with a 1 year mortality approximating 20 % [1]. HF can present in patients without previously recognized cardiac dysfunction or as the acute decompensation of chronic congestive HF. Acute Decompensated Heart Failure (ADHF) refers broadly to new or worsening of signs and symptoms of HF that is progressing rapidly, whereby unscheduled medical care or hospital evaluation is necessary. A number of national registries have been developed in the last few decades which have provided invaluable epidemiological and clinical information to help guide the management of patients with ADHF. Currently the total number of patients in the Acute Decompensated Heart Failure National Registry (ADHERE), [2] the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) [3] and the EuroHeart Failure Survey (EHFS) [4] exceeds 250,000. The mean age of the patients in these registries is around 72 years with 50 % being women. Evidence of mild or no impairment of systolic function was found in approximately 45 % of patients. The most common co-morbid conditions were hypertension, coronary artery disease, chronic obstructive pulmonary disease (COPD) and diabetes. In-hospital mortality was approximately 4 % and the median hospital length of stay was 4.5 days.