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Novel Therapies for the Prevention and Management of Acute Decompensated Heart Failure

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Pharmacologic Trends of Heart Failure

Part of the book series: Current Cardiovascular Therapy ((CCT))

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Abstract

Acute decompensated heart failure continues to be a leading cause of hospital admissions in the U.S. and is the leading cause of hospitalization in patients >65 years of age [1]. Over the past three decades significant advances in understanding the complex pathophysiology has lead to the development of medical therapies that have improved outcome, unfortunately the overall mortality rate remains staggeringly high, 50 % at 5 years [2]. Hospitalizations for acute decompensated heart failure (ADHF) are a huge burden to the already over taxed health care system. Even with the advances in the medical therapies, the 30-day readmission rate for ADHF is 25 % [3]. While the management of chronic stable heart failure has progressed, the management strategies and therapies for ADHF have changed little in the same time period [4]. The mainstay therapies for the management of ADHF are focused on rapidly improving symptoms of dyspnea, peripheral edema and decongesting the patient. Intravenous diuretics are recommended for decongestion and volume removal in all patients with evidence of significant volume overload. Concomitant use of IV vasodilators (nitroprusside, nitroglycerin and neseritide) in patients without evidence of hypotension can aid in decongestion and improve symptoms. In patients with reduced EF and evidence of decreased perfusion and hemodynamic compromise, intravenous inotropes can be used to improve and maintain cardiac output and end-organ perfusion. However none of the therapies have been shown to improve (and may actually increase) morbidity and mortality [5].

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Authors and Affiliations

  1. Heart Transplant Institute, Baptist Health Transplant Institute, Little Rock, AR, USA

    Patrick T. Campbell MD

  2. Department of Cardiology, University of Illinois College of Medicine at Peaoria, Peoria, IL, USA

    Sepehr Saberian MD

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  1. Patrick T. Campbell MD
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  2. Sepehr Saberian MD
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Correspondence to Patrick T. Campbell MD .

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  1. Department of Cardiology, Ochsner Health System, New Orleans, Louisiana, USA

    Hector O. Ventura

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Campbell, P.T., Saberian, S. (2016). Novel Therapies for the Prevention and Management of Acute Decompensated Heart Failure. In: Ventura, H. (eds) Pharmacologic Trends of Heart Failure. Current Cardiovascular Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-30593-6_2

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