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Acute heart failure

An unmet medical need

Akutes Herzversagen

Ein unerfüllter medizinischer Bedarf

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Abstract

Despite recent advances in the management of heart failure with reduced ejection fraction (HFrEF), the burden of acute heart failure (AHF) remains significant with a high morbidity and mortality that has not been improved by any treatment modality. A meta-analysis summarized the study results on the effects of tolvaptan on AHF, which failed to demonstrate an improvement in short-term and long-term mortality, length of hospital stay and reduced frequency of worsening heart failure (WHF). Similar trial results were also reported in other AHF studies, such as the ASCEND-HF and the RELAX-AHF-2 trials. In view of these inconclusive studies it is evident that improving the prognosis of AHF patients remains an unmet medical need. Further efforts should focus on organ damage protection, individualized treatment, patient benefits and standardized management programs, including immediate identification and management of cardiogenic shock and establishment of HF networks for close monitoring of AHF patients.

Zusammenfassung

Trotz jüngster Fortschritte im Management der Herzinsuffizienz mit reduzierter Ejektionsfraktion (HFrEF) bleibt die Belastung des akuten Herzversagens („acute heart failure“, AHF) mit hoher Morbidität und Mortalität signifikant und konnte bisher durch kein Behandlungsverfahren verbessert werden. Eine Metaanalyse fasste die Studienergebnisse zu den Auswirkungen von Tolvaptan auf AHF zusammen, das keine Verbesserung in Kurzzeit- und Langzeitmortalität, Hospitalisationsdauer und reduzierter Häufigkeit einer Verschlimmerung der Herzinsuffizienz („worsening heart failure“, WHF) zeigen konnte. Ähnliche Ergebnisse wurden auch in anderen AHF-Studien berichtet, wie z. B. der ACENT-HF- und der RELAX-AHF-2-Studie. In Anbetracht dieser nicht eindeutigen Studienlage stellt die Verbesserung der Prognose von AHF-Patienten offensichtlich einen unerfüllten medizinischen Bedarf dar. Zukünftige Bemühungen sollten auf den Schutz vor Organschäden, die individuelle Behandlung, den Nutzen für die Patienten sowie standardisierte Management-Programme fokussieren, einschließlich der sofortigen Identifizierung und des Managements eines kardiogenen Schocks sowie der Einrichtung von Herzinsuffizienz-Netzwerken für ein engmaschiges Monitoring von AHF-Patienten.

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Abbreviations

AHF:

Acute heart failure

HF:

Heart failure

HFrEF:

Heart failure with reduced ejection fraction

IABP:

Intra-aortic balloon pump

LVAD:

Left ventricular assist devices

LVEF:

Left ventricular ejection fraction

MCS:

Mechanical circulatory support

WHF:

Worsening heart failure

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Author information

Authors and Affiliations

  1. Department of Internal Medicine III – Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Ernst-Grube-Strasse 40, Halle (Saale), 06120, Germany

    A. G. Rigopoulos MD, S. Sakellaropoulos MD, M. Teren MD, M. Matiakis MD &  M. Noutsias MD, FESC, FHFA

  2. 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece

    C. Bakogiannis MD, PhD

  3. Cardiology Unit, Presidio Sanitario Intermedio, “Elena d’Aosta”, Napoli, Italy

    R. de Vecchis MD

  4. Department of Cardiology, Asklepios Harzklinik Goslar, Goslar, Germany

    M. Ali MD

  5. Department of Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany

    C. Tschoepe MD

  6. Deutsches Zentrum für Herz Kreislaufforschung (DZHK)—Standort Berlin, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany

    C. Tschoepe MD

  7. Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany

    C. Tschoepe MD

Authors
  1. A. G. Rigopoulos MD
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  2. C. Bakogiannis MD, PhD
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  3. R. de Vecchis MD
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  4. S. Sakellaropoulos MD
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  5. M. Ali MD
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  6. M. Teren MD
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  7. M. Matiakis MD
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  8. C. Tschoepe MD
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  9. M. Noutsias MD, FESC, FHFA
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Corresponding author

Correspondence to M. Noutsias MD, FESC, FHFA.

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Conflict of interests

A.G. Rigopoulos, R. de Vecchis, S. Sakellaropoulos, M. Ali, M. Teren and M. Matiakis declare that they have no competing interests. C. Bakogiannis was employed by Novartis from August 2013 to July 2015. M. Noutsias received grants from the Deutsche Forschungsgemeinschaft (DFG) through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19) (TP B2) and from the University Hospital Gießen and Marburg Foundation Grant “T cell functionality” (UKGM 10/2009). He was consultant to the Institute for Cardiac Diagnosis and Therapy (IKDT, Berlin) from June 2004 to June 2008, and received fees for presentations and/or participation in advisory boards from AstraZeneca, Bayer, Fresenius, Miltenyi Biotech, Novartis, Pfizer and Zoll and is the local principal investigator (p. i.) of the trials RELAX-AHF-2, TRUE-HF and TRANSITION trials at the University Hospital Jena. C. Tschoepe received a grant by the DFG (SFB TR19 TP B5 and Z3).

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Angelos G. Rigopoulos and Constantinos Bakogiannis contributed equally to this work.

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Rigopoulos, A.G., Bakogiannis, C., de Vecchis, R. et al. Acute heart failure. Herz 44, 53–55 (2019). https://doi.org/10.1007/s00059-017-4626-6

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