acute heart failure. - clinical trial results 2016 hf guidelines/acute hf... · acute heart failure...
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Acute heart failureVeli-Pekka HarjolaFHFA, FESCCoordinator of the acute heart failure committee of the HFAHelsinki, Finland
2016 ESC Guidelines
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12. Acute heart failure
12.1. Definition and classification 12.2. Diagnosis and initial prognostic evaluation12.3. Management12.3.1. Identification of precipitants/causes leading to decompensation which need urgent management 12.3.2. Criteria for hospitalization in ward versus intensive/coronary care unit 12.3.3. Management of the early phase 12.3.4. Management of patients with cardiogenic shock12.4. Management of evidence-based oral therapies12.5. Monitoring of clinical status of patients hospitalized due to acute heart failure12.6. Criteria for discharge from hospital and follow-up in high-risk period 12.7. Goals of treatment during the different stages of management of acute heart failure
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What is new in 2016 guidelines for AHF?
• The concept of an early initiation of appropriate therapy going along with
identification of acute etiology
• follows “time to therapy” approach well established in acute coronary syndrome (ACS)
• A new algorithm for a combined diagnosis and treatment approach of acute HF,
based on the clinical presentation: presence/absence of congestion/hypoperfusion
• Structured recommendations with class of recommendation and level of evidence given to all the main elements of management from diagnosis, monitoring and therapies to postdischarge follow-up
Individual case-by-case interpretation of recommendations have to be consistent with the level of evidence
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Recommendations regarding applied diagnostic measurements in suspected AHF
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Causes of elevated concentrations ofnatriuretic peptides
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Factors triggering acute heart failure
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Clinical profiles of patients with acute HF based on the presence/absence of congestion and/or hypoperfusion
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Initial management of a patient with acute HF
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Initial management of a patient with acute HF (1)
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Initial management of a patient with acute HF (2)
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Management of patients with acute heart failure based on clinical profile during an early phase
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Management of patients with acute heart failure based on clinical profile during an early phase
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Recommendations for the management of patients with acute heart failure: pharmacotherapy
Given for each main drug category
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Recommendations regarding monitoring, oxygen therapy and ventilatory support
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Recommendations regarding renal replacementtherapy in patients with acute heart failure
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Recommendations regarding oral evidence-baseddisease-modifying therapies in patients with AHF
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Recommendations regarding management of patients with cardiogenic shock
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Recommendations regarding monitoring of clinicalstatus of patients hospitalized due to acute heart failure
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Goals of treatment in acute heart failure
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Gaps in knowledge in AHF
• Prospective evaluation of the ‘time-to-treatment’ concept in AHF • Evaluation whether inadequate phenotyping is responsible for the
failure of treatments to improve outcome in AHF • Better definition and treatment of diuretic resistance• Role of nitrates in the management of AHF • Treatments improving mortality and morbidity• Strategies and therapies to prevent early rehospitalization after
discharge for a hospital admission for AHF.
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Thank you
21.5.2016