Update: Acute Heart Failure (I)
Acute Heart Failure: Epidemiology, Risk Factors, and PreventionInsuficiencia cardiaca aguda: epidemiología, factores de riesgo y prevención

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Abstract

Acute heart failure represents the first cause of hospitalization in elderly persons and is the main determinant of the huge healthcare expenditure related to heart failure. Despite therapeutic advances, the prognosis of acute heart failure is poor, with in-hospital mortality ranging from 4% to 7%, 60- to 90-day mortality ranging from 7% to 11%, and 60- to 90-day rehospitalization from 25% to 30%. Several factors including cardiovascular and noncardiovascular conditions as well as patient-related and iatrogenic factors may precipitate the rapid development or deterioration of signs and symptoms of heart failure, thus leading to an acute heart failure episode that usually requires patient hospitalization. The primary prevention of acute heart failure mainly concerns the prevention, early diagnosis, and treatment of cardiovascular risk factors and heart disease, including coronary artery disease, while the secondary prevention of a new episode of decompensation requires the optimization of heart failure therapy, patient education, and the development of an effective transition and follow-up plan.

Resumen

La insuficiencia cardiaca aguda constituye la primera causa de hospitalización en las personas ancianas y es el principal factor determinante del enorme gasto de asistencia sanitaria asociado a la insuficiencia cardiaca. A pesar de los avances terapéuticos realizados, la insuficiencia cardiaca aguda tiene un mal pronóstico, con una mortalidad hospitalaria que oscila entre el 4 y el 7%, una mortalidad a los 60 a 90 días de entre el 7 y el 11% y una tasa de rehospitalizaciones a los 60 a 90 días que va del 25 al 30%. Hay varios factores, entre los que se encuentran los trastornos cardiovasculares y no cardiovasculares, así como factores relacionados con el paciente y factores iatrogénicos, que pueden desencadenar una progresión rápida o un agravamiento de los signos y síntomas de insuficiencia cardiaca, lo que conduce a un episodio de insuficiencia cardiaca aguda que suele requerir el ingreso hospitalario del paciente. La prevención primaria de la insuficiencia cardiaca aguda se centra principalmente en la prevención, el diagnóstico precoz y el tratamiento de los factores de riesgo cardiovascular y la cardiopatía, incluida la enfermedad coronaria, mientras que la prevención secundaria para evitar nuevos episodios de descompensación requiere la optimización del tratamiento de la insuficiencia cardiaca, la educación sanitaria del paciente y el desarrollo de una transición y un plan de seguimiento efectivos.

Introduction

Acute heart failure (AHF) is the rapid development or change of signs and symptoms of heart failure that requires medical attention and usually leads to patient hospitalization.1, 2, 3 Acute heart failure represents the first cause of hospital admission in elderly persons in the western world and, despite advances in medical and device therapy, it still has unacceptably high morbidity and mortality rates. As a result, AHF represents a major public health issue, an enormous financial burden, and a challenge for current cardiovascular research.3

Section snippets

Epidemiology

A number of large-scale registries, such as the ADHERE4, 5, 6 and OPTIMIZE-HF performed in the United States,4, 5, 6, 7 the EHFS I and II8, 9, 10 and the ESC-HF Pilot registry performed in Europe,8, 9, 10, 11 as well as the international ALARM-HF12 have provided us with some epidemiological evidence on AHF.

Patients admitted for AHF are aged > 70 years and about half of them are male. Most have a previous history a heart failure, while de novo AHF represents only one-fourth to one-third of

Risk factors

Several cardiovascular and noncardiovascular conditions may cause a rapid development or deterioration of signs and symptoms of heart failure leading to hospitalization. A detailed list of the causes and precipitating factors leading to AHF is provided in Table 3. Heart failure accounts for less than half of readmission causes. More specifically, according to the EVEREST trial, 46% of patients are admitted because of heart failure, while 39% are hospitalized because of noncardiovascular

Prevention

Primary prevention of AHF concerns the prevention and early diagnosis and treatment of the causes of heart failure (Table 3) and mainly of cardiovascular risk factors and heart disease. Coronary artery disease is the cause in two-thirds of heart failure patients, particularly those with reduced LVEF, while arterial hypertension is found in approximately 70% of patients, particularly those with preserved LVEF.3 Therefore, timely and effective treatment of risk factors for atherosclerosis,

CONFLICT OF INTERESTS

G. Filippatos is a member of steering committees of acute heart failure trials sponsored by Novartis, Cardiorentis, the European Union and Bayer. J. Parissis has received fees for conference presentations from Novartis International.

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