title: Acute decompensated heart failure: update on new and emerging evidence and directions for future research.
abstract: Acute decompensated heart failure (ADHF) is a complex clinical event associated with excess morbidity and mortality. Managing ADHF patients is challenging because of the lack of effective treatments that both reduce symptoms and improve clinical outcomes. Existing guideline recommendations are largely based on expert opinion, but several recently published trials have yielded important data to inform both current clinical practice and future research directions. New insight has been gained regarding volume management, including dosing strategies for intravenous loop diuretics and the role of ultrafiltration in patients with heart failure and renal dysfunction. Although the largest ADHF trial to date (ASCEND-HF, using nesiritide) was neutral, promising results with other investigational agents have been reported. If these findings are confirmed in phase III trials, novel compounds, such as relaxin, omecamtiv mecarbil, and ularitide, among others, may become therapeutic options. Translation of research findings into quality clinical care can not be overemphasized. Although many gaps in knowledge exist, ongoing studies will address issues around delivery of evidence-based care to achieve the goal of improving the health status and clinical outcomes of patients with ADHF.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. mgivertz@partners.org
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Westlake Canary
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin-Adams
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
authors.forename: Rajan
authors.initials: R
authors.lastname: Krishnamani
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.forename: Mary N
authors.initials: MN
authors.lastname: Walsh
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
authors.forename: John P
authors.initials: JP
authors.lastname: Dimarco
authors.forename: Ray E
authors.initials: RE
authors.lastname: Hershberger
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004039:Diet, Sodium-Restricted; D004232:Diuretics / Q000008:administration & dosage; D004298:Dopamine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D006020:Glycopeptides / Q000097:blood; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D006440:Hemofiltration; D006760:Hospitalization; D006801:Humans; D045283:Natriuretic Agents / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D010446:Peptide Fragments / Q000097:blood / Q000627:therapeutic use; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011787:Quality of Health Care; D012065:Relaxin / Q000627:therapeutic use; D018570:Risk Assessment; D012462:Saline Solution, Hypertonic; D014508:Urea / Q000031:analogs & derivatives / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D014970:Xanthines / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D004232:Diuretics; D006020:Glycopeptides; D045283:Natriuretic Agents; D010446:Peptide Fragments; D011498:Protein Precursors; D012462:Saline Solution, Hypertonic; D014665:Vasodilator Agents; D014970:Xanthines; C048197:copeptins; C109794:pro-brain natriuretic peptide (1-76); C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; C547293:omecamtiv mecarbil; C056452:Ularitide; C073525:rolofylline; D009320:Atrial Natriuretic Factor; D014508:Urea; D012065:Relaxin; D005996:Nitroglycerin; D004298:Dopamine