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Acute Heart Failure: Clinical Management

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Prof. Dr. Serafina Valente

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Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, 53100 Siena, Italy
Interests: acute heart failure; cardiogenic shock; mechanical circulatory support; heart transplantation; left ventricular assist device

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine will highlight the current state of the art and showcase some of the latest findings in the field of acute heart failure. The scientific discussion about acute heart failure and its management is of particular relevance, due to its fairly high incidence as well as the high mortality rate of these patients. The need for multiparametric approaches both to early diagnosis as well as prompt treatment through comprehensive risk stratification is fundamental in order to reduce morbidity and mortality.

This Special Issue aims to provide researchers with an opportunity to publish both original research and review articles related to recent advances in the acute heart failure and cardiogenic shock fields, with a particular focus on early diagnosis, risk stratification, advanced treatment strategies including mechanical circulatory support, heart transplantation and long-term left ventricular assist devices. In this setting, it is important to highlight both personalized management, tailored to each patient, as well as an interdisciplinary approach to acute heart failure management

Prof. Dr. Serafina Valente
Guest Editor

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15 pages, 1455 KiB

Open AccessArticle

Diagnosis and Treatment of Acute Heart Failure: A Retrospective Observational Study and Medical Audit

by Justas Suchina, Giorgia Lüthi-Corridori, Fabienne Jaun, Jörg D. Leuppi and Maria Boesing

J. Clin. Med. 2024, 13(19), 5951; https://doi.org/10.3390/jcm13195951 - 7 Oct 2024

Cited by 1 | Viewed by 1806

Abstract

Background: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. Methods: This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. Results: The study included 760 AHF cases of 726 patients (median age 84 years, range 45–101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. Conclusions: We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable. Full article

(This article belongs to the Special Issue Acute Heart Failure: Clinical Management)

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14 pages, 1491 KiB

Open AccessArticle

Predicting One-Year Mortality after Discharge Using Acute Heart Failure Score (AHFS)

by Mariarosaria Magaldi, Erika Nogue, Nicolas Molinari, Nicola De Luca, Anne-Marie Dupuy, Florence Leclercq, Jean-Luc Pasquie, Camille Roubille, Grégoire Mercier, Jean-Paul Cristol and François Roubille

J. Clin. Med. 2024, 13(7), 2018; https://doi.org/10.3390/jcm13072018 - 30 Mar 2024

Viewed by 1796

Abstract

Background: Acute heart failure (AHF) represents a leading cause of unscheduled hospital stays, frequent rehospitalisations, and mortality worldwide. The aim of our study was to develop a bedside prognostic tool, a multivariable predictive risk score, that is useful in daily practice, thus providing an early prognostic evaluation at admission and an accurate risk stratification after discharge in patients with AHF. Methods: This study is a subanalysis of the STADE HF study, which is a single-centre, prospective, randomised controlled trial enrolling 123 patients admitted to hospital for AHF. Here, 117 patients were included in the analysis, due to data exhaustivity. Regression analysis was performed to determine predictive variables for one-year mortality and/or rehospitalisation after discharge. Results: During the first year after discharge, 23 patients died. After modellisation, the variables considered to be of prognostic relevance in terms of mortality were (1) non-ischaemic aetiology of HF, (2) elevated creatinine levels at admission, (3) moderate/severe mitral regurgitation, and (4) prior HF hospitalisation. We designed a linear model based on these four independent predictive variables, and it showed a good ability to score and predict patient mortality with an AUC of 0.84 (95%CI: 0.76–0.92), thus denoting a high discriminative ability. A risk score equation was developed. During the first year after discharge, we observed as well that 41 patients died or were rehospitalised; hence, while searching for a model that could predict worsening health conditions (i.e., death and/or rehospitalisation), only two predictive variables were identified: non-ischaemic HF aetiology and previous HF hospitalisation (also included in the one-year mortality model). This second modellisation showed a more discrete discriminative ability with an AUC of 0.67 (95% C.I. 0.59–0.77). Conclusions: The proposed risk score and model, based on readily available predictive variables, are promising and useful tools to assess, respectively, the one-year mortality risk and the one-year mortality and/or rehospitalisations in patients hospitalised for AHF and to assist clinicians in the management of patients with HF aiming at improving their prognosis. Full article

(This article belongs to the Special Issue Acute Heart Failure: Clinical Management)

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