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Acute HF English Group
Acute HF English Group
Study characteristics
Pt number 105388 48612 11327 3580 4953 4862
Pts characteristics
Age, mean (yo) 72 73 71 69.9 66-70 73
Known HF (%) 75 87 65 63 64 36
Preserved LVEF (%) 40 51 55 34 25 46.6
Outcomes
In-hospital mortality (%) 4 4 6.9 6.7 11 21
30-90 day mortality (%) 11.2 9 6.6 -- -- --
Readmission rate (%) 22.1 30 24 -- -- --
Pathophysiology of AHF: 4 key pathogenic
mechanisms
Congestion
No Yes
Hypoperfusion
No
Yancy CW et al. 2013 ACCF/AHA Guideline for the management of HF. Circulation 2013;128:1810-52.
Acute pulmonary edema: main characteristics
Overall (%)
Pneumonia (%)
Hypertension (%)
Arrhythmia (%)
Ischemia (%)
0 1 2 3 4 5 6 7 8 9
Close monitoring of O2 saturation, BP, HR, urine output and fluid balance
Regular blood sampling for acid-base and electrolyte balance (Astrup),
preferably from arterial blood
Assess frequently creatinine, urea and eGFR and electrolytes, mainly
Na+ and K+
Classify pts subtypes:
“wet and cold” and “wet and warm”: highest risk of death
Urgent mechanical circulatory support
Thromboprophylaxis 1A 1B 1B
Treatment of AHF with cardiogenic shock:
“cold and wet” patients
Aim:
increase cardiac output and contractility
Optimize tissue perfusion and end-organ function
O2 4-6 l/min per facial mask in hypoxic pts
Vasodilators: contraindicated
Inotropic therapy: recommended by all guidelines
Stabilize and salvage
Bridge to mechanical circulatory support or transplantation
None improve survival, some increase mortality
Classes of medication:
Sympatho-mymetics (dobutamine, NE)
Phosphodiesterase (PDE) inhibitors (milrinone, enoximone)
Calcium sensitizers (levosimendan)
Increase O2 consumption and risk of arrhythmias
Mechanisms of action of current positive
inotropic drugs
Inotropic and vasopressor drugs used to treat AHF