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Fernández Rodríguez JM, Casado J, Formiga F, González-Franco A, Arévalo JC, Beltrán M, Cerqueiro González JM, Llàcer P, Manzano L, Morales-Rull JL, Silvestre JP, Conde-Martel A. Consensus on basic conduct during the hospital admission of patients with acute heart failure. Rev Clin Esp 2021; 221:283-296. [PMID: 32139076 DOI: 10.1016/j.rce.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
Acute heart failure (AHF) is a highly prevalent clinical entity in individuals older than 45years in Spain. AHF is associated with significant morbidity and mortality and is the leading cause of hospitalisation for individuals older than 65years in Spain, a quarter of whom die within 1year of the hospitalisation. In recent years, there has been an upwards trend in hospitalisations for AHF, which increased 76.7% from 2003 to 2013. Readmissions at 30days for AHF have also increased (from 17.6% to 22.1%), at a relative mean rate of 1.36% per year, with the consequent increase in the use of resources and the economic burden for the healthcare system. The aim of this document (developed by the Heart Failure and Atrial Fibrillation Group of the Spanish Society of Internal Medicine) is to guide specialists on the most important aspects of treatment and follow-up for patients with AHF during hospitalisation and the subsequent follow-up. The main recommendations listed in this document are as follows: (1)At admission, perform a comprehensive assessment, considering the patient's standard treatment and comorbidities, given that these determine the disease prognosis to a considerable measure. (2)During the first few hours of hospital care, decongestive treatment is a priority, and a staged diuretic therapeutic approach based on the patient's response is recommended. (3)To manage patients in the stable phase, consider starting and/or adjusting evidence-based drug treatment (e.g., sacubitril/valsartan or angiotensin-converting enzyme inhibitors/angiotensinII receptor blockers, beta blockers and aldosterone antagonists). (4)At hospital discharge, use a checklist to optimise the patient's management and identify the most efficient options for maintaining continuity of care after discharge.
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Affiliation(s)
- J M Fernández Rodríguez
- Servicio de Medicina Interna, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, España
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - F Formiga
- Servicio de Medicina Interna, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - A González-Franco
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, España
| | - J C Arévalo
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
| | - M Beltrán
- Servicio de Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda, Cádiz, España
| | | | - P Llàcer
- Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, España
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, España
| | - J L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - J Pérez Silvestre
- Servicio de Medicina Interna, Unidad Insuficiencia Cardiaca Paciente Crónico y Edad Avanzada, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, España.
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Fernández Rodríguez JM, Casado J, Formiga F, González-Franco Á, Arévalo JC, Beltrán M, Cerqueiro González JM, Llàcer P, Manzano L, Morales-Rull JL, Pérez Silvestre J, Conde-Martel A. Consensus on basic conduct during the hospital admission of patients with acute heart failure. Rev Clin Esp 2021; 221:283-296. [PMID: 33998516 DOI: 10.1016/j.rceng.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
Acute heart failure (AHF) is a highly prevalent clinical entity in individuals older than 45 years in Spain. AHF is associated with significant morbidity and mortality and is the leading cause of hospitalisation for individuals older than 65 years in Spain, a quarter of whom die within 1 year of the hospitalisation. In recent years, there has been an upwards trend in hospitalisations for AHF, which increased 76.7% from 2003 to 2013. Readmissions at 30 days for AHF have also increased (from 17.6% to 22.1%), at a relative mean rate of 1.36% per year, with the consequent increase in the use of resources and the economic burden for the healthcare system. The aim of this document (developed by the Heart Failure and Atrial Fibrillation Group of the Spanish Society of Internal Medicine) is to guide specialists on the most important aspects of treatment and follow-up for patients with AHF during hospitalisation and the subsequent follow-up. The main recommendations listed in this document are as follows: 1) At admission, perform a comprehensive assessment, considering the patient's standard treatment and comorbidities, given that these determine the disease prognosis to a considerable measure. 2) During the first few hours of hospital care, decongestive treatment is a priority, and a staged diuretic therapeutic approach based on the patient's response is recommended. 3) To manage patients in the stable phase, consider starting and/or adjusting evidence-based drug treatment (e.g., sacubitril/valsartan or angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta blockers and aldosterone antagonists). 4) At hospital discharge, use a checklist to optimise the patient's management and identify the most efficient options for maintaining continuity of care after discharge.
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Affiliation(s)
- J M Fernández Rodríguez
- Servicio de Medicina Interna, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, Spain
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Á González-Franco
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J C Arévalo
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain
| | - M Beltrán
- Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda, Cádiz, Spain
| | | | - P Llàcer
- Servicio de Medicina Interna, Hospital de Manises, Valencia, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - J L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J Pérez Silvestre
- Servicio de Medicina Interna, Unidad Insuficiencia Cardíaca Paciente Crónico y Edad Avanzada, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Spain.
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Toth PP, Gauthier D. Heart failure with preserved ejection fraction: strategies for disease management and emerging therapeutic approaches. Postgrad Med 2020; 133:125-139. [PMID: 33283589 DOI: 10.1080/00325481.2020.1842620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Approximately 50% of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing relative to HF with reduced ejection fraction (HFrEF). Both types of HF are associated with reduced survival and increased risk for hospitalization. However, in contrast to HFrEF, there are no approved treatments specifically indicated for HFpEF, and current therapy is largely focused on management of symptoms and comorbidities. Diagnosis of HFpEF in the outpatient setting also presents unique challenges compared with HFrEF because of factors including a high burden of comorbidities in HFpEF and difficulties in distinguishing HFpEF from normal aging. Primary care providers (PCPs) play a pivotal role in the delivery of holistic, patient-centric care from diagnosis to management and palliative care. As the prevalence of HF continues to rise in an aging population, PCPs will need to play a greater role in HFpEF care. This article will review HFpEF etiology and pathophysiology, diagnostic workup, and management of symptoms and comorbidities, with a focus on the critical role of PCPs throughout the clinical course of HFpEF.
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Affiliation(s)
- Peter P Toth
- Preventive Cardiology, CGH Medical Center, Rock Falls, IL, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Gauthier
- Section of Cardiology, Boston University School of Medicine, Boston, MA, USA
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