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Short Stay Management of Acute Heart Failure pp 197–210Cite as

Acute Decompensated Heart Failure in the Observation Unit: Treatment Protocols

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Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Treatment of acute decompensated heart failure (ADHF) patients remains challenging. There is limited data from randomized controlled trials of these patients in the emergency department (ED), much less the observation unit (OU). As a result, there has been little consensus regarding their management, adding to the inconsistent care these patients receive. Only recently have guidelines emerged to provide clinicians a framework from which to work. This chapter will focus on therapeutic management, with respect to general supportive measures and pharmacologic therapy, and most importantly, specific treatment protocols that can be implemented in the OU.

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References

  1. Peacock WF, Fonarow GC, Ander DS, et al. Society of Chest Pain Centers recommendations for the evaluation and management of the observation stay acute heart failure patient-parts 1-6. Acute Card Care. 2009;11:3–42.

    Article  PubMed  Google Scholar 

  2. Masip J, Roque M, Sánchez B, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005;294(24):3124–30.

    Article  CAS  PubMed  Google Scholar 

  3. Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. 2008;359:142–51.

    Article  CAS  PubMed  Google Scholar 

  4. Bussmann W, Schupp D. Effect of sublingual nitroglycerin in emergency treatment of severe pulmonary edema. Am J Cardiol. 1978;41:931–6.

    Article  CAS  PubMed  Google Scholar 

  5. Teerlink JR, Walsh MN. Executive summary: HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16:475–539.

    Article  Google Scholar 

  6. Gottlieb SS, Brater DC, Thomas I, et al. BG9719 (CVT-124), an A1 adenosine receptor antagonist, protects against the decline in renal function observed with diuretic therapy. Circulation. 2002;105(11):1348–53.

    Article  CAS  PubMed  Google Scholar 

  7. Brewster UC, Setaro JF, Perazella MA. The renin-angiotensin-aldosterone system: cardiorenal effects and implications for renal and cardiovascular disease states. Am J Med Sci. 2003;326(1):15–24.

    Article  PubMed  Google Scholar 

  8. Salvador DRK, Punzalan FE, Ramos GC. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane Database Syst Rev. 2005;(3):CD003178. doi: 10.1002/14651858. CD003178.pub3.

  9. Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351:389–93.

    Article  CAS  PubMed  Google Scholar 

  11. Hamilton RJ, Carter WA, Gallagher EJ. Rapid improvement of acute pulmonary edema with sublingual captopril. Acad Emerg Med. 1996;3:205–12.

    Article  CAS  PubMed  Google Scholar 

  12. Peacock WF, Emerman C, Costanzo MR, et al. Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail. 2009;15:256–64.

    Article  CAS  PubMed  Google Scholar 

  13. Publication Committee for the VMAC Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287:1531–40.

    Google Scholar 

  14. Elkayam U, Akhter MW, Singh H, et al. Comparison of effects on left ventricular filling pressure of intravenous nesiritide and high-dose nitroglycerin in patients with decompensated heart failure. Am J Cardiol. 2004;93:237–40.

    Article  CAS  PubMed  Google Scholar 

  15. Fonarow GC, on behalf of the ADHERE Scientific Advisory Committee. The Acute Decompensated Heart Failure National Registry (ADHERE): opportunities to improve care of patients hospitalized with acute decompensated heart failure. Rev Cardiovasc Med. 2003;4 Suppl 7:S21–30.

    Google Scholar 

  16. Peacock WF, Holland R, Gyamarthy R, Dunbar L, Klapholz M, Horton DP, de Lissovoy G, Emerman CL. Observation unit treatment of heart failure with nesiritide: results from the PROACTION trial. J Emerg Med. 2005;29(3):243–52.

    Google Scholar 

  17. Sackner-Bernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation. 2005;111:1487–91.

    Article  CAS  PubMed  Google Scholar 

  18. Sackner-Bernstein JD, Kowalski M, Fox M, et al. Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA. 2005;293:1900–5.

    Article  CAS  PubMed  Google Scholar 

  19. Califf R. LBCT I, Abstract 21828. Presented at: American Heart Association Scientific Sessions 2010; 13–17 Nov; Chicago.

    Google Scholar 

  20. Cuffe MS, Califf RM, Adams KF, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287:1541–7.

    Article  CAS  PubMed  Google Scholar 

  21. Abraham WT, Adams KF, Fonarow GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the ADHERE registry. J Am Coll Cardiol. 2005;46:57–64.

    Article  PubMed  Google Scholar 

  22. Fonarow GC, Adams KF, Abraham WT, et al. for the ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293:572–80.

    Google Scholar 

  23. Gheorghiade M, Abraham WT, Albert NM, et al.; for the OPTIMIZE-HF Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure Investigators and Coordinators. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296:2217–26.

    Google Scholar 

  24. Peacock WF, De Marco T, Fonarow GC, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358:2117–26.

    Article  CAS  PubMed  Google Scholar 

  25. Fonarow GC, Peacock WF, Phillips CO, et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007;49:1943–50.

    Article  CAS  PubMed  Google Scholar 

  26. Fermann GJ, Collins SP. Observation units in the management of acute heart failure syndromes. Curr Heart Fail Rep. 2010;7:125–33.

    Article  PubMed  Google Scholar 

  27. DiDomenico RJ, Park HY, Southworth MR, et al. Guidelines for acute decompensated heart failure treatment. Ann Pharmacother. 2004;38:649–60.

    Article  PubMed  Google Scholar 

  28. Reingold S, Kulstad E. Impact of human factor design on the use of order sets in the treatment of congestive heart failure. Acad Emerg Med. 2007;14:1097–110.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Texas Southwestern, Medical Center, 5323 Harry Hines Blvd, Dallas, Tx, 75390, USA

    John Pease MD, FACEP

  2. Parkland Health and Hospital System, Dallas, Tx, USA

    John Pease MD, FACEP

Authors
  1. John Pease MD, FACEP
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Correspondence to John Pease MD, FACEP .

Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, Baylor College of Medicine, HOUSTON, Texas, USA

    W. Frank Peacock

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Pease, J. (2017). Acute Decompensated Heart Failure in the Observation Unit: Treatment Protocols. In: Peacock, W. (eds) Short Stay Management of Acute Heart Failure. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-44006-4_15

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  • DOI: https://doi.org/10.1007/978-3-319-44006-4_15

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-44005-7

  • Online ISBN: 978-3-319-44006-4

  • eBook Packages: MedicineMedicine (R0)

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