European Heart Journal Advance Access originally published online on January 28, 2005
European Heart Journal 2005 26(4):384-416; doi:10.1093/eurheartj/ehi044
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure
The Task Force on Acute Heart Failure of the European Society of Cardiology
Endorsed by the European Society of Intensive Care Medicine (ESICM) Authors/Task Force Members,
ESC Committee for Practice Guidelines (CPG),
Document Reviewers,
* Corresponding author. Chairperson: Markku S. Nieminen, Division of Cardiology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. Tel.: +358 94717 22 00; fax: +358 9 4717 40 15. E-mail address: markku.nieminen@hus.fi
| The first 150 words of the full text of this article appear below. |
Preamble
Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making.
A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and by different organizations and other related societies. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents.
In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published
1. Introduction
2. Epidemiology, aetiology, and clinical context
I. Definitions, diagnostic steps, instrumentation and monitoring of the patient with AHF
3. Definition and clinical classification of AHF
3.1. Definition
3.1.1. Killip classification.
3.1.2. Forrester classification.
3.1.3. ‘Clinical severity’ classification.
3.2. The clinical syndrome of AHF
3.2.1. Forward (left and right) AHF.
3.2.2. Left-heart backward failure.
3.2.3. Right-heart backward failure.
4. Pathophysiology of AHF
4.1. The vicious circle in the acute failing heart
4.2. Myocardial stunning
4.3. Hibernation
5. Diagnosis of AHF
5.1. Clinical evaluation
5.2. Electrocardiogram (ECG)
5.3. Chest X-ray and imaging techniques
5.4. Laboratory tests
5.5. Echocardiography
5.6. Other investigations
6. Goals of the treatment of AHF
6.1. Organization of the treatment of AHF
7. Instrumentation and monitoring of patients in AHF
7.1. Non-invasive monitoring
7.2. Invasive monitoring
7.2.1. Arterial line.
7.2.2. Central venous pressure lines.
7.2.3. Pulmonary artery catheter.
II. Treatment of AHF
8. General medical issues in the treatment of AHF
9. Oxygen and ventilatory assistance
9.1. Rationale for using oxygen in AHF
9.2. Ventilatory support without endotracheal intubation (non-invasive ventilation)
9.2.1. Rationale.
9.2.2. Evidence for the use of CPAP and NIPPV in left ventricular failure.
9.2.3. Conclusions.
9.3. Mechanical ventilation with endotracheal intubation in AHF
10. Medical treatment
10.1. Morphine and its analogues in AHF
10.2. Anticoagulation
10.3. Vasodilators in the treatment of AHF
10.3.1. Nitrates.
10.3.2. Sodium nitroprusside.
10.3.3. Nesiritide.
10.3.4. Calcium antagonists.
10.4. Angiotensin converting enzyme (ACE)-inhibitors in AHF
10.4.1. Indications.
10.4.2. Effects and mechanism of action.
10.4.3. Practical use.
10.5. Diuretics
10.5.1. Indications.
10.5.2. Effects and mechanisms of action.
10.5.3. Practical use.
10.5.4. Diuretic resistance.
10.5.5. Secondary effects, drug interactions.
10.5.6. New diuretic agents.
10.6. ß-blocking agents
10.6.1. Indications and rationale for ß-blocking agents.
10.6.2. Practical use.
10.7. Inotropic agents
10.7.1. Clinical indications.
10.7.2. Dopamine.
10.7.3. Dobutamine.
10.7.4. Practical use.
10.7.5. Phosphodiesterase inhibitors.
10.7.6. Levosimendan.
10.7.7. Vasopressor therapy in cardiogenic shock.
10.7.8. Cardiac glycosides.
11. Underlying diseases and co-morbidities in AHF
11.1. Coronary artery disease
11.2. Valvular disease
11.3. Management of AHF due to prosthetic valve thrombosis (PV T)
11.4. Aortic dissection
11.5. AHF and hypertension
11.6. Renal failure
11.7. Pulmonary diseases and bronchoconstriction
11.8. Arrhythmias and AHF
11.8.1. Bradyarrhythmias.
11.8.2. Supraventricular tachycardia (SVT).
11.8.3. Recommendations for treatment of supraventricular tachyarrhythmias in AHF.
11.8.4. Treatment of life-threatening arrhythmias.
11.9. Peri-operative AHF
12. Surgical treatment of AHF
12.1. AHF related to complications of AMI
12.1.1. Free wall rupture.
12.1.2. Post-infarction ventricular septal rupture (VSR).
12.1.3. Acute mitral regurgitation.
13. Mechanical assist devices and heart transplantation
13.1. Indication
13.1.1. Intra-aortic balloon counterpulsation (IABC).
13.1.2. Ventricular assist devices.
13.2. Heart transplantation
14. Summary comments
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A. Clerico, M. Fontana, L. Zyw, C. Passino, and M. Emdin Comparison of the Diagnostic Accuracy of Brain Natriuretic Peptide (BNP) and the N-Terminal Part of the Propeptide of BNP Immunoassays in Chronic and Acute Heart Failure: A Systematic Review Clin. Chem., May 1, 2007; 53(5): 813 - 822. [Abstract] [Full Text] [PDF]
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M. Gheorghiade, M. A. Konstam, J. C. Burnett Jr, L. Grinfeld, A. P. Maggioni, K. Swedberg, J. E. Udelson, F. Zannad, T. Cook, J. Ouyang, et al. Short-term Clinical Effects of Tolvaptan, an Oral Vasopressin Antagonist, in Patients Hospitalized for Heart Failure: The EVEREST Clinical Status Trials JAMA, March 28, 2007; 297(12): 1332 - 1343. [Abstract] [Full Text] [PDF]
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L. A. Allen and C. M. O'Connor Management of acute decompensated heart failure Can. Med. Assoc. J., March 13, 2007; 176(6): 797 - 805. [Abstract] [Full Text] [PDF]
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J. Camm, H. Klein, and S. Nisam The cost of implantable defibrillators: perceptions and reality Eur. Heart J., February 2, 2007; 28(4): 392 - 397. [Abstract] [Full Text] [PDF]
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K. McDonald, C. Conlon, and M. Ledwidge Disease management programs for heart failure: Not just for the 'sick' heart failure population Eur J Heart Fail, February 1, 2007; 9(2): 113 - 117. [Abstract] [Full Text] [PDF]
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O. Milo-Cotter, K. F. Adams, C. M. O'Connor, N. Uriel, E. Kaluski, G. M. Felker, B. Weatherley, Z. Vered, and G. Cotter Acute heart failure associated with high admission blood pressure -- A distinct vascular disorder? Eur J Heart Fail, February 1, 2007; 9(2): 178 - 183. [Abstract] [Full Text] [PDF]
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Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]
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K. Siirila-Waris, J. Lassus, J. Melin, K. Peuhkurinen, M. S. Nieminen, V.-P. Harjola, and for the FINN-AKVA study group Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure Eur. Heart J., December 2, 2006; 27(24): 3011 - 3017. [Abstract] [Full Text] [PDF]
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C-H Huang, M-S Tsai, C-C Hsieh, T-D Wang, W-T Chang, and W-J Chen Diagnostic accuracy of tissue Doppler echocardiography for patients with acute heart failure Heart, December 1, 2006; 92(12): 1790 - 1794. [Abstract] [Full Text] [PDF]
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J. Coste, P. Jourdain, and J. Pouchot A Gray Zone Assigned to Inconclusive Results of Quantitative Diagnostic Tests: Application to the Use of Brain Natriuretic Peptide for Diagnosis of Heart Failure in Acute Dyspneic Patients Clin. Chem., December 1, 2006; 52(12): 2229 - 2235. [Abstract] [Full Text] [PDF]
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M. S. Nieminen, D. Brutsaert, K. Dickstein, H. Drexler, F. Follath, V.-P. Harjola, M. Hochadel, M. Komajda, J. Lassus, J. L. Lopez-Sendon, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population Eur. Heart J., November 2, 2006; 27(22): 2725 - 2736. [Abstract] [Full Text] [PDF]
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R. Cortes, M. Portoles, A. Salvador, V. Bertomeu, F. G. de Burgos, L. Martinez-Dolz, E. R. Lleti, V. Climent, A. Jordan, R. Paya, et al. Diagnostic and prognostic value of urine NT-proBNP levels in heart failure patients Eur J Heart Fail, October 1, 2006; 8(6): 621 - 627. [Abstract] [Full Text] [PDF]
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Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
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L. Groban and J. Butterworth Perioperative management of chronic heart failure. Anesth. Analg., September 1, 2006; 103(3): 557 - 575. [Abstract] [Full Text] [PDF]
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L. De Luca, W. S. Colucci, M. S. Nieminen, B. M. Massie, and M. Gheorghiade Evidence-based use of levosimendan in different clinical settings Eur. Heart J., August 2, 2006; 27(16): 1908 - 1920. [Abstract] [Full Text] [PDF]
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K.-H. Kuck and S. Nisam ICD therapy: 'the sickest benefit the most...': what about the less sick? Europace, July 1, 2006; 8(7): 508 - 511. [Abstract] [Full Text] [PDF]
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L. Tavazzi, A. P. Maggioni, D. Lucci, G. Cacciatore, G. Ansalone, F. Oliva, M. Porcu, and on behalf of the Italian survey on Acute Heart Fai Nationwide survey on acute heart failure in cardiology ward services in Italy Eur. Heart J., May 2, 2006; 27(10): 1207 - 1215. [Abstract] [Full Text] [PDF]
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M. R. Cowie, M. Komajda, T. Murray-Thomas, J. Underwood, B. Ticho, and on behalf of the POSH Investigators Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH) Eur. Heart J., May 2, 2006; 27(10): 1216 - 1222. [Abstract] [Full Text] [PDF]
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L Purek, K Laule-Kilian, A Christ, T Klima, M E Pfisterer, A P Perruchoud, and C Mueller Coronary artery disease and outcome in acute congestive heart failure Heart, May 1, 2006; 92(5): 598 - 602. [Abstract] [Full Text] [PDF]
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