Guidelines for acute decompensated heart failure treatment.
OBJECTIVE
To describe the development of guidelines for the treatment of acute decompensated heart failure (ADHF) in the emergency department/observation unit (ED-OU) setting for hospitals that are part of a group purchasing organization (GPO).


METHODS
A MEDLINE search (1966-March 2003) using the following search terms: cardiotonic agents; diuretic; dobutamine; heart failure, congestive; milrinone; natriuretic peptide, brain; nesiritide; nitroglycerin; vasodilator agents, was conducted.


METHODS
Relevant articles in the English language were identified. All randomized studies and meta-analyses for each category of drugs were included.


RESULTS
A group consensus method was used to develop guidelines. An expert panel reviewed and revised the guidelines. The final guidelines were approved June 1, 2003, and are described here. They are organized based upon a patient's symptomatology at the time the diagnosis of ADHF is made. Patients with evidence of volume overload require intravenous diuretics and/or intravenous vasodilators to alleviate the symptoms of ADHF. Patients with signs and symptoms of low cardiac output require inotropic support to manage their ADHF. A timeline for diagnosis, treatment, reassessment, and disposition is provided and encourages an early, aggressive approach to treating patients with ADHF.


CONCLUSIONS
Hospitalization for ADHF is common and costly. Consensus guidelines for the treatment of ADHF did not previously exist, resulting in inconsistent and inefficient treatment. Consequently, hospitals struggling with the treatment of ADHF may find these guidelines and the process by which they were developed useful.
DiDomenico
Robert J
RJ
Department of Pharmacy Practice, Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL 60612-7230, USA.
Park
Hayley Y
HY
Southworth
Mary Ross
MR
Eyrich
Heather M
HM
Lewis
Richard K
RK
Finley
Jamie M
JM
Schumock
Glen T
GT
D000208:Acute Disease; D002303:Cardiac Output, Low / Q000188:drug therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D014665:Vasodilator Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents