Acute Heart Failure: Diagnostic–Therapeutic Pathways and Preventive Strategies—A Real-World Clinician’s Guide
Ciro Mauro, Salvatore Chianese, Rosangela Cocchia, Michele Arcopinto, Stefania Auciello, Valentina Capone, Mariano Carafa, Andreina Carbone, Giuseppe Caruso, Rossana Castaldo, Rodolfo Citro, Giulia Crisci, Antonello D’Andrea, Roberta D’Assante, Maria D’Avino, Francesco Ferrara, Antonio Frangiosa, Domenico Galzerano, Vincenzo Maffei, Alberto M. Marra, Rahul Mehta, Rajendra H. Mehta, Fiorella Paladino, Brigida Ranieri, Monica Franzese, Giuseppe Limongelli, Salvatore Rega, Luigia Romano, Andrea Salzano, Chiara Sepe, Olga Vriz, Raffaele Izzo, Filippo Cademartiri, Antonio Cittadini, Eduardo Bossone
Abstract
Acute heart failure (AHF) is the most frequent cause of unplanned hospital admission in patients of >65 years of age and it is associated with significantly increased morbidity, mortality, and healthcare costs. Different AHF classification criteria have been proposed, mainly reflecting the clinical heterogeneity of the syndrome. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of cases. Furthermore, a marked reduction in cardiac output with peripheral hypoperfusion may occur in most severe cases. Diagnosis is made on the basis of signs and symptoms, laboratory, and non-invasive tests. After exclusion of reversible causes, AHF therapeutic interventions mainly consist of intravenous (IV) diuretics and/or vasodilators, tailored according to the initial hemodynamic status with the addition of inotropes/vasopressors and mechanical circulatory support if needed. The aim of this review is to discuss current concepts on the diagnosis and management of AHF in order to guide daily clinical practice and to underline the unmet needs. Preventive strategies are also discussed.