Acute heart failure Veli-Pekka Harjola FHFA, FESC Coordinator of - - PowerPoint PPT Presentation

Acute heart failure

Veli-Pekka Harjola FHFA, FESC Coordinator of the acute heart failure committee of the HFA Helsinki, Finland 2016 ESC Guidelines

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• 12. Acute heart failure

12.1. Definition and classification 12.2. Diagnosis and initial prognostic evaluation 12.3. Management 12.3.1. Identification of precipitants/causes leading to decompensation which need urgent management 12.3.2. Criteria for hospitalization in ward versus intensive/coronary care unit 12.3.3. Management of the early phase 12.3.4. Management of patients with cardiogenic shock 12.4. Management of evidence-based oral therapies 12.5. Monitoring of clinical status of patients hospitalized due to acute heart failure 12.6. Criteria for discharge from hospital and follow-up in high-risk period 12.7. Goals of treatment during the different stages of management of acute heart failure

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What is new in 2016 guidelines for AHF?

• The concept of an early initiation of appropriate therapy going along with

identification of acute etiology

• follows “time to therapy” approach well established in acute coronary syndrome (ACS)
• A new algorithm for a combined diagnosis and treatment approach of acute HF,

based on the clinical presentation: presence/absence of congestion/hypoperfusion

• Structured recommendations with class of recommendation and level of evidence

given to all the main elements of management from diagnosis, monitoring and therapies to postdischarge follow-up Individual case-by-case interpretation of recommendations have to be consistent with the level of evidence

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Recommendations regarding applied diagnostic measurements in suspected AHF

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Causes of elevated concentrations of natriuretic peptides

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Factors triggering acute heart failure

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Clinical profiles of patients with acute HF based on the presence/absence of congestion and/or hypoperfusion

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Initial management

• f a patient

with acute HF

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Initial management of a patient with acute HF (1)

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Initial management of a patient with acute HF (2)

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Management of patients with acute heart failure based

• n clinical profile

during an early phase

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Management of patients with acute heart failure based on clinical profile during an early phase

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Recommendations for the management of patients with acute heart failure: pharmacotherapy

Given for each main drug category

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Recommendations regarding monitoring, oxygen therapy and ventilatory support

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Recommendations regarding renal replacement therapy in patients with acute heart failure

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Recommendations regarding oral evidence-based disease-modifying therapies in patients with AHF

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Recommendations regarding management of patients with cardiogenic shock

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Recommendations regarding monitoring

• f clinical

status of patients hospitalized due to acute heart failure

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Goals of treatment in acute heart failure

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Gaps in knowledge in AHF

• Prospective evaluation of the ‘time-to-treatment’ concept in AHF
• Evaluation whether inadequate phenotyping is responsible for the

failure of treatments to improve outcome in AHF

• Better definition and treatment of diuretic resistance
• Role of nitrates in the management of AHF
• Treatments improving mortality and morbidity
• Strategies and therapies to prevent early rehospitalization after

discharge for a hospital admission for AHF.

www.escardio.org/ guidelines Thank you

21.5.2016