Optimizing outcomes in the patient with acute decompensated heart failure

American Heart Journal
Mandeep R Mehra

Abstract

Heart failure (HF) and episodes of acute decompensated HF (ADHF) continue to pose a substantial clinical challenge in the United States and represent a significant source of morbidity, mortality, and health care resource use. Recent therapeutic advances have shifted ADHF treatment paradigms from diuretic management with or without inotrope use to therapy where intravenous vasodilators are the central component, above a background of diuretics. This shift in treatment has resulted in more rapid symptomatic improvements as well as in decreases in overall morbidity and mortality. Elevated left ventricular filling pressure has become an important clinical target for resolution during ADHF, as this parameter most closely correlates with degree of symptoms, extent of ischemic complications, and the deleterious neurohormonal activation in response to ADHF. Therapies that lead to rapid improvements in left ventricular filling pressure, including the use of nesiritide, a recombinant analog of B-type natriuretic peptide, have been shown to provide rapid symptomatic relief, but effects on long-term morbidity and mortality are as yet unclear. In addition to new treatments, new technologies--including assays based on cardiac biomarkers and ...Continue Reading

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Citations

Jul 24, 2008·Current Treatment Options in Cardiovascular Medicine·Jennifer R BrownMandeep R Mehra
Jul 16, 2010·The American Journal of Emergency Medicine·Gaspare ParrinelloGiuseppe Licata
Oct 18, 2008·Journal of Cardiac Failure·Gaspare ParrinelloGiuseppe Licata
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Apr 7, 2012·International Anesthesiology Clinics·Christoph K HoferWanda M Popescu

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