[Therapeutic strategies in acute decompensated heart failure and cardiogenic shock].
As the population of elderly people is increasing, the number of patients requiring hospitalization for acute exacerbations is rising. Traditionally, these episodes of hemodynamic instability were viewed as a transient event characterized by systolic dysfunction, low cardiac output, and fluid overload. Diuretics, along with vasodilator and inotropic therapy, eventually became elements of standard care. In a multicenter observational registry (ADHERE--Acute Decompensated Heart Failure National Registry) of more than 275 hospitals, patients with acute decompensated heart failure were analyzed for their characteristics and treatments options. These data have shown that this population consists of multiple types of heart failure, various forms of acute decompensation, combinations of comorbidities, and varying degrees of disease severity. The challenges in the treatment require multidisciplinary approaches since patients typically are elderly and have complex combinations of comorbidities. So far only a limited number of drugs is currently available to treat the different groups. Over the past years it was shown that even "standard drugs" might be deleterious by induction of myocardial injury, worsening of renal function or increasing mortality upon treatment. Therefore, based on pathophysiology, different types of acute decompensated heart failure require specialized treatment strategies.
Buerke
M
M
Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany. michael.buerke@medizin.uni-halle.de
Lemm
H
H
Russ
M
M
Schlitt
A
A
Werdan
K
K
D000368:Aged; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003422:Critical Care; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006835:Hydrazones / Q000009:adverse effects / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D009204:Myocardial Revascularization; D011157:Population Dynamics; D011724:Pyridazines / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D000077464:Simendan; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use
D002316:Cardiotonic Agents; D004232:Diuretics; D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan