Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group.
Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF.
Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee. Electronic address: sean.collins@vanderbilt.edu.
Sean P
SP
Collins
Department of Emergency Medicine, Wayne State University, Detroit, Michigan.
Phillip D
PD
Levy
Department of Emergency Medicine, SUNY Downstate, New York, New York.
Jennifer L
JL
Martindale
Department of Medicine, Case Western University, Cleveland, Ohio.
Mark E
ME
Dunlap
Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee.
Alan B
AB
Storrow
Department of Emergency Medicine, Indiana University, Indianapolis, Indiana.
Peter S
PS
Pang
Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
Nancy M
NM
Albert
Department of Medicine, Duke University, Raleigh-Durham, North Carolina.
G Michael
GM
Felker
Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
Gregory J
GJ
Fermann
Department of Medicine, University of California, Los Angeles, California.
Gregg C
GC
Fonarow
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Michael M
MM
Givertz
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Judd E
JE
Hollander
Department of Medicine, Henry Ford Health System, Detroit, Michigan.
David J
DJ
Lanfear
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Daniel J
DJ
Lenihan
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
JoAnn M
JM
Lindenfeld
Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
W Frank
WF
Peacock
Department of Medicine, Maine Medical Center, Portland, Maine.
Douglas B
DB
Sawyer
Department of Medicine, San Francisco VA Medical Center, San Francisco, California.
John R
JR
Teerlink
Department of Medicine, Stony Brook University, Long Island, New York.
Javed
J
Butler
D000208:Acute Disease; D035843:Biomedical Research; D032921:Consensus; D019468:Disease Management; D004635:Emergency Medicine / Q000379:methods*; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D012955:Societies, Medical; D014481:United States
Emergency; Heart failure; Hypertension