Management strategies for stage-D patients with acute heart failure

Heart Failure (HF) accounted for 3.4 mill ambulatory visits in 2000. Current guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC), the Heart Failure Society of America (HSFA), and the International Society for Heart & Lung Transplantation (ISHLT) recommend aggressive pharmacologic interventions for patients with HF. This may include a combination of diuretics, angiotensin-converting enzyme (ACE) inhibitors, β-blockers, angiotensin-receptor blockers (ARBs), aldosterone antagonists, and digoxin. Nitrates and hydralazine are also indicated as part of standard therapy in addition to β-blockers and ACE inhibitors, especially but not exclusively, for African Americans with left ventricular (LV) systolic dysfunction. For those with acute decompensated HF, additional treatment options include recombinant human B-type natriuretic peptide, and in the future possible newer agents not yet approved for use in the United States, such as Levosimendan. Medical devices for use in patients with advanced HF include LV assist devices, cardiac resynchronization therapy, and implantable cardioverter defibrillators. For refractory patients heart transplantation, the gold-standard surgical intervention for the treatment of refractory HF, may be considered. Newer surgical options such as surgical ventricular restoration may be considered in select patients.