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Heart failure and sepsis: practical recommendations for the optimal management

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Abstract

Acute heart failure (AHF) is a common clinical challenge that a wide spectrum of physicians encounters in every practice. In many cases, AHF is due to decompensation of chronic heart failure. This decompensation may be triggered by various reasons, with sepsis being a notable one. Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection and is associated with a very high mortality, which may reach 25%. Alarmingly, the increase in the mortality rate of patients with combined cardiac dysfunction and sepsis is extremely high (may reach 90%). Thus, these patients need urgent intervention. Management of patients with AHF and sepsis is challenging since cornerstone interventions for AHF may be contraindicated in sepsis and vice versa (e.g., diuretic treatment). Unfortunately, no relevant guidelines are yet available, and treatment remains empirical. This review attempts to shed light on the intricacies of the available interventions and suggests routes of action based on the existing bibliography.

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Author information

Author notes

  1. Angelos Arfaras-Melainis and Eftihia Polyzogopoulou contributed equally to this work.

Authors and Affiliations

  1. Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, 122 43, Chaidari, Greece

    Angelos Arfaras-Melainis, Ignatios Ikonomidis & John Parissis

  2. Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 122 43, Chaidari, Athens, Greece

    Eftihia Polyzogopoulou

  3. Department of Cardiology, Larissa University General Hospital, 413 34, Larissa, Greece

    Filippos Triposkiadis & Andrew Xanthopoulos

  4. INSERM UMR-S 942, Université Paris Diderot - PRES Sorbonne Paris Cité, Department of Anesthesiology and Critical Care Medicine, AP-HP Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010, Paris, France

    Alexander Mebazaa

Authors
  1. Angelos Arfaras-Melainis
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  2. Eftihia Polyzogopoulou
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  3. Filippos Triposkiadis
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  4. Andrew Xanthopoulos
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  5. Ignatios Ikonomidis
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  6. Alexander Mebazaa
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  7. John Parissis
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Corresponding author

Correspondence to Angelos Arfaras-Melainis.

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Conflict of interest

John Parissis and Alexandre Mebazaa received honoraria for lectures and advisory meetings from ORION Pharma and ROCHE Diagnostics.

Angelos Arfaras-Melainis, Eftihia Polyzogopoulou, Andrew Xanthopoulos, Filippos Triposkiadis, and Ignatios Ikonomidis have no disclosures to make concerning this manuscript.

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Arfaras-Melainis, A., Polyzogopoulou, E., Triposkiadis, F. et al. Heart failure and sepsis: practical recommendations for the optimal management. Heart Fail Rev 25, 183–194 (2020). https://doi.org/10.1007/s10741-019-09816-y

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