PRIMEVIEW

ACUTE HEART FAILURE

For the Primer, visit doi:10.1038/s41572-020-0151-7

Acute heart failure (AHF) is a Non-compliance MANAGEMENT

MECHANISMS
syndrome characterized by signs
and symptoms of heart failure (HF). Arrhythmias
Myocardial ischaemia The cornerstone of AHF management is
AHF can occur in individuals without
decongestive therapy, with diuretics in case of fluid
a previous history of HF (de novo HF)
Precipitating Infection and/or sepsis retention and vasodilators for fluid redistribution.
when a new-onset cardiac dysfunction is
factors can trigger Endothelial dysfunction The underlying cause and any precipitating factors
sufficient to induce HF or an underlying
the onset of AHF or should also be addressed, and, whenever possible,
but undiagnosed cardiac dysfunction is suddenly worsen a disease-modifying therapy should be started or
worsened by one or more precipitating Uncontrolled hypertension
HF symptoms updated during hospitalization. A long-term care
factors. However, most cases of AHF The
plan should be in place before discharge; integrate
occur in patients with chronic HF (acutely pathophysiology
the roles of the patient, health-care professionals
decompensated HF (ADHF)). of AHF is very
and other care-givers; and aim to improve quality
heterogeneous, as it
of life, delay disease progression and reduce the
Neuroendocrine depends on the specific
activation underlying cardiac TKUMQH|TGJQURKVCNK\CVKQP
EPIDEMIOLOGY
ntion dysfunction and
Fluid redte LV diast
an /ortion dysfunctioolinc precipitating
The Global Burden of Disease study estimated redistribu
factors
>37 million cases of HF in 2010, and almost
all hospitalizations for HF are related to signs
of fluid retention, indicating probable AHF. LONG-TERM
Rehospitalization rates in the first 3 months after
an episode of AHF can reach ~30%. stolic
MANAGEMENT
Pulmonary LV dia stolic
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function • 6CMG[QWTOGFKEKPGU
deteriorates, • Eat healthy
fluid retention (in the
interstitial space) and/or Systemic • %JGEMKPYKVJ[QWTFQEVQT
fluid redistribution (due to congestion • -PQYVJGUKIPU
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of vascular beds) occur, d function more than
leading to pulmonary and hypoperfusion,
OUTLOOK
DIAGNOSIS U[UVGOKE|EQPIGUVKQP particularly kidney
function
No drug is formally approved for AHF, as most
Individuals with systemic congestion (excessive clinical trials had neutral or negative results;
fluid accumulation) present with dyspnoea ACUTE HEART FAILURE however, such results might stem from the
(shortness of breath), orthopnoea (dyspnoea when PREVENTION QUALITY OF LIFE difficulty in setting appropriate primary end points
lying down) and fatigue, often associated with and drug administration regimens. New drugs
peripheral oedema, jugular vein distention and As ADHF accounts for most cases of AHF, prevention In addition to the physical symptoms, are being investigated, as well as diagnostic and
pulmonary rales. No available biomarker is specific of worsening HF is paramount. Patient education hospitalization can reduce the quality of life prognostic markers. As rehospitalization rates
for AHF; thus, the diagnostic work-up should should highlight the importance of compliance of patients with AHF and lead to or worsen are high, particularly in the first months after
include a comprehensive assessment of the clinical with drug therapy and avoidance of contraindicated cognitive impairment and depressed mood. In an episode of AHF, risk stratification algorithms
manifestations, the underlying cardiac dysfunction drugs, how to recognize early signs and symptoms turn, poor quality of life can affect compliance enabling clinicians to identify high-risk patients are
CPFCP[RTGEKRKVCVKPI|HCEVQTU and when to contact the health-care system. with treatment. being sought.

doi:10.1038/s41572-020-0157-1; Article citation ID: (2020) 6:17 Written by Lucia Brunello; designed by Laura Marshall
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