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J Am Coll Cardiol, 2009; 53:557-573, doi:10.1016/j.jacc.2008.10.041
© 2009 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Acute Heart Failure Syndromes

Mihai Gheorghiade, MD, FACC*,* and Peter S. Pang, MD{dagger}

* Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
{dagger} Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Manuscript received July 2, 2008; revised manuscript received October 21, 2008, accepted October 26, 2008.

* Reprint requests and correspondence: Dr. Mihai Gheorghiade, Professor of Medicine and Surgery, Northwestern University Feinberg School of Medicine, Division of Cardiology, 676 N. St. Clair, Suite 600, Chicago, Illinois 60611 (Email: m-gheorghiade{at}northwestern.edu).

Heart failure resulting in hospitalization represents a significant and growing health care burden. Heterogeneity characterizes this group in terms of mode of presentation, pathophysiology, and prognosis. The vast majority of patients symptomatically improve during hospitalization; however, their early post-discharge rehospitalization and mortality rates continue to be high. Worsening signs and symptoms, neurohormonal, and renal abnormalities occurring soon after discharge may contribute to these high post-discharge event rates. Currently available assessment modalities combined with recent advances in cardiovascular therapies provide present-day opportunities to improve post-discharge outcomes. Further investigation into pathophysiologic targets and novel approaches to clinical trial design are needed. Improving post-discharge outcomes is the single most important goal in the management of acute heart failure syndromes.

Key Words: heart • failure • decompensated • acute • syndromes

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  AHFS = acute heart failure syndromes
  ARB = angiotensin receptor blocker
  BNP = B-type natriuretic peptide
  BP = blood pressure
  BW = body weight
  CAD = coronary artery disease
  CRT = chronic resynchronization therapy
  EF = ejection fraction
  HF = heart failure
  IV = intravenous
  LVFP = left ventricular filling pressure
  MI = myocardial infarction
  PCWP = pulmonary capillary wedge pressure
  PSF = preserved systolic function
  SBP = systolic blood pressure


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