Management of Acute Decompensated Heart Failure in Hospitalized Patients

To review the current in-hospital management of patients with acute decompensated heart failure (ADHF). Review of the literature. Heart failure is a leading cause of hospitalization in the elderly, and morbidity, mortality, and hospital readmission rates for ADHF remain high. The patient's hemodynamic status along with the use of prognostic models for short-term mortality may facilitate patient triage and encourage the use of evidence-based therapy, especially in high-risk patients. Initial treatment should target the relief of congestive symptoms, and intravenous loop diuretics are the mainstay of therapy. The preferred IV vasoactive medication has yet to be determined in a large prospective randomized trial. Positive inotropic agents should be reserved for patients with signs of low cardiac output and tissue hypoperfusion; however, the risk/benefit equation should be evaluated judiciously with each treatment option before initiating therapy. For patients with refractory hemodynamic collapse, ventricular assist devices can allow stabilization until recovery or decision regarding transplantation versus destination therapy. Patients with ADHF are at increased risk for readmission to the hospital as well as at increased risk for death. Risk factors need to be identified and referral to a heart disease management program should be considered for those patients deemed at increased risk for rehospitalization.