title: Challenges in acute heart failure clinical management: optimizing care despite incomplete evidence and imperfect drugs.
abstract: Acute heart failure is a common condition associated with considerable morbidity, mortality, and cost. However, evidence-based data on treating heart failure in the acute setting are limited, and current individual treatment options have variable efficacy. The healthcare team must often individualize patient care in ways that may extend beyond available clinical guidelines. In this review, we address the question, "How do you do the best you can clinically with incomplete evidence and imperfect drugs?" Expert opinion is provided to supplement guideline-based recommendations and help address the typical challenges that are involved in the management of patients with acute heart failure. Specifically, we discuss 4 key areas that are important in the continuum of patient care: differential diagnosis and risk stratification; choice and implementation of initial therapy; assessment of the adequacy of therapy during hospitalization or observation; and considerations for discharge/transition of care. A case study is presented to highlight the decision-making process throughout each of these areas. Evidence is accumulating that should help guide patients and healthcare providers on a path to better quality of care.
authors: From *Teichman Cardiology Research, Oakland, CA; †Veterans Affairs San Diego Healthcare System, San Diego, and University of California, San Diego, La Jolla, CA; and ‡Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors: Sam L
authors: SL
authors: Teichman
authors: Alan S
authors: AS
authors: Maisel
authors: Alan B
authors: AB
authors: Storrow
mesh_terms: D000208:Acute Disease; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D011785:Quality Assurance, Health Care
chemical_list: D002317:Cardiovascular Agents