Abstract
It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation. Guidelines on AHF management have highlighted that the currently administered AHF therapies lack evidence and have raised concerns on the safety and efficacy of some of the hitherto accepted treatment modalities. Additionally, the high mortality and morbidity rates associated with the current AHF therapies also add to the imperative need to revisit AHF management. The last decade has witnessed a paradigm shift in the way we define and diagnose AHF. Apart from it being recognized as a distinct clinical entity, research has also led to new data on the pathophysiological changes associated with AHF. These developments along with the limited short- and long-term effects of currently used therapies may herald a paradigm shift in the way we plan and deliver management strategies to treat the pathological progression of heart failure.
Highlights
Clinical and epidemiological evidence derived from studies carried out in the United States, Canada, Japan, Western and Eastern Europe indicate that presentation of the acute heart failure (AHF) patients to the emergency department (ED), their background etiologies, precipitating factors, and existing co-morbidities are marked by large heterogenity
Chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation
Clinical and epidemiological evidence derived from studies carried out in the United States, Canada, Japan, Western and Eastern Europe indicate that presentation of the AHF patients to the emergency department (ED), their background etiologies, precipitating factors, and existing co-morbidities are marked by large heterogenity
Summary
Clinical and epidemiological evidence derived from studies carried out in the United States, Canada, Japan, Western and Eastern Europe indicate that presentation of the AHF patients to the emergency department (ED), their background etiologies, precipitating factors, and existing co-morbidities are marked by large heterogenity. This heterogeneity is observed in the treatment strategies and the overall management of these patients from the time of ED admission to their long-term followup. A survey in nine European countries (SHAPE, 2005) exploring general awareness about heart failure has shown that out of almost 8000 inhabitants only 3% could identify heart failure from a description of the symptoms and signs; 31% of subjects could identify angina and 51% stroke [18]
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