Best of heart failure

62 Expanded algorithm for managing patients with acute decompensated heart failure Joyce N. Njoroge 1 & Baljash Cheema 1 & Andrew P. Ambrosy 2 & Stephen J. Greene 2 & Sean P. Collins 3 & Muthiah Vaduganathan 4 & Alexandre Mebazaa 5,6 & Ovidiu Chioncel 7,8 & Javed Butler 9 & Mihai Gheorghiade 1 Published online: 3 April 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Heart failure is a complex disease process, the manifestation of various cardiac and noncardiac abnormalities. General treatment approaches for heart failure have remained the same over the past decades despite the advent of novel therapies and monitoring modalities. In the same vein, the readmission rates for heart failure patients remain high and portend a poor prognosis for morbidity and mortality. In this context, development and implementation of improved algorithms for assessing and treating HF patients during hospitalization remains an unmet need. We propose an expanded algorithm for both monitoring and treating patients admitted for acute decompensated heart failure with the goal to improve post-discharge outcomes and decrease rates of rehospitalizations. Keywords Heart failure . Acute decompensated heart failure, rehospitalizations . HFrEF Introduction Heart failure is not a single disease, but a heterogeneous clin- ical syndrome that is the manifestation of various cardiac and noncardiac abnormalities. It is commonly seen in individuals 65 years and older and is associated with high rates of morbid- ity and mortality [ 1 ]. Patients hospitalized for heart failure with reduced ejection fraction (HFrEF) have a mortality and read- mission rate as high as 15 and 30%, respectively, at 60 – 90 days post-discharge which has remained unchanged in the past de- cade despite the advent of novel therapies and monitoring mo- dalities [ 2 ]. Hospitalization and rehospitalizations are strong predictors of negative outcomes such as mortality in heart fail- ure (HF) patients [ 3 ]. In this context, development and imple- mentation of improved algorithms for assessing and treating HF patients during hospitalization remains an unmet need. In this article, we propose and provide rationale for the use of the following systematic approach during the three phases of hospitalization (initial assessment, inpatient, and post-dis- charge): (1) adopt a regimented framework for assessing and treating acute decompensated HF, (2) treat beyond clinical congestion, (3) augment use of underused therapies known to improve outcomes, (4) identify and treat noncardiac comor- bidities, and (5) emphasize importance of post-discharge fol- low-up visits. The aim is to utilize tools and strategies for purposes of improving post-discharge clinical outcomes and decreasing rates of rehospitalization. Adopt a regimented approach to assessing and treating acute decompensated heart failure The approach to managing acute decompensated HF (ADHF) patients admitted to the hospital has not changed significantly * Joyce N. Njoroge joyce.njoroge@northwestern.edu 1 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA 2 Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA 3 Vanderbilt University Medical Center, Nashville, TN, USA 4 Brigham and Women ’ s Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA 5 Department of Anesthesia and Critical Care, Inserm U942, Hôpitaux Universitaires Saint-Louis-Lariboisière, Paris, France 6 University Paris Diderot, Paris, France 7 Institute of Emergency for Cardiovascular Diseases B Prof C.C.Iliescu ^ , Bucharest, Romania 8 University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 9 Department of Medicine, University of Mississippi, Oxford, MS, USA Heart Failure Reviews (2018) 23:597 – 607 https://doi.org/10.1007/s10741-018-9697-9