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International Groups Seek More Urgent Treatment of Acute Heart Failure

DES PLAINES, IL – Why is acute coronary syndrome (ACS) treated as an urgent diagnosis requiring immediate response but acute heart failure (AHF) often is not?

That question led the Society for Academic Emergency Medicine and several European groups to issue joint recommendations which were published recently in the European Heart Journal.

"This is the first guidance to insist that acute heart failure (AHF) is like acute coronary syndrome (ACS) in that it needs urgent diagnosis and appropriate treatment,” noted lead author Alexandre Mebazaa, MD, PhD, of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). “In ACS, when the coronary is occluded we say 'time is muscle' which means that the quicker the vessel is dilated, the more heart muscle is saved. The same principle is true for AHF."

Mebazaa said the goal is to achieve in AHF similar reductions in mortality and morbidity as seen with ACS. The way to do that, he added, is by “introducing the time to therapy concept together with new medications for AHF.”

Early treatment of AHF patients can decrease mortality and morbidity, added co-author Professor Abdelouahab Bellou, MD, PhD, past president of the European Society for Emergency Medicine.

"Failure to treat quickly aggravates underlying chronic heart failure and can induce complications including cardiogenic shock and acute respiratory distress,” Bellou said. “Patients may need to be intubated which can increase their risk of mortality."

The joint recommendations include:

  • An algorithm for the management of AHF;
  • Tests and treatments to be performed pre-hospital, and in the ED, coronary care unit (CCU) or intensive care unit (ICU);
  • Guidance on the role of nurses in the management of AHF;
  • Instructions on how to use oxygen therapy and ventilation support;
  • Advice on managing new and currently prescribed medicines, and
  • Criteria for discharge from hospital and recommendations for follow up.

AHF treatment is complicated by patient anxiety, Mebazaa pointed out, explaining, "Dyspnea causes more anxiety for patients, families and doctors than chest pain. Anxiety is also caused by low oxygen levels in the brain. Unfortunately there are no medications to relax patients without worsening their respiration and blood oxygen levels. But we can reduce anxiety by talking to patients and families and giving oxygen."

Background information in the study notes that from 30-40% of discharged AHF patients are back in the hospital within 30 days.

"Inconsistency in medicine is never good for patients,” Mebazaa added. “Many patients with AHF are hospitalized many times and may receive different treatment for the same event in the emergency room, ICU or CCU. We hope to standardize care by recommending best contemporary practices based on the latest evidence."