russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/15604071-2024-5915SVTBVPrussjcardiol-5915Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON THE ISSUEОбзор и адаптация клинических рекомендаций по острой сердечной недостаточности Европейской федерации внутренней медициныReview and adaptation of European Federation of Internal Medicine clinical guidelines on acute heart failurehttps://orcid.org/0000-0001-7825-5597ЛаринаВ. Н.LarinaV. N.

д. м. н., профессор, зав. кафедрой поликлинической терапии лечебного факультета.

Москва

MD, PhD, D.Sc. (Medicine), Professor, Head of Department of Outpatient Medicine of Faculty of General Medicine.

Moscow

larinav@mail.ruhttps://orcid.org/0000-0001-8614-6542КокоринВ. А.KokorinV. A.

д. м. н., доцент, профессор кафедры госпитальной терапии им. акад. П.Е. Лукомского лечебного факультета; и. о. зав. кафедрой госпитальной терапии с курсами эндокринологии, гематологии и клинической лабораторной диагностики медицинского института.

Москва

MD, PhD, D.Sc. (Medicine), associate professor, professor of the Department of hospital therapy named after academician P.E. Lukomsky, Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation; Acting Head of Department of Hospital Therapy with courses in endocrinology, hematology and clinical laboratory diagnostics, Peoples' Friendship University of Russia named after Patrice Lumumba.

Moscow

valentinkokorin@yahoo.comhttps://orcid.org/0000-0001-9002-7749ЛуневВ. И.LunevV. I.

к. м. н., ассистент кафедры поликлинической терапии лечебного факультета.

Москва

MD, PhD, Assistant Professor of department of Outpatient Medicine of Faculty of General Medicine.

Moscow

sandvit@yandex.ruhttps://orcid.org/0000-0001-5959-6759СувороваН. А.SuvorovaN. A.

к. м. н., ассистент кафедры госпитальной терапии им. акад. П.Е. Лукомского лечебного факультета.

Москва

MD, PhD, assistant at the Department of hospital therapy named after academician P.E. Lukomsky.

Moscow

natalia-suvorova@inbox.ruФГАОУ ВО Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава РоссиРоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ ВО Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава России; ФГАОУ ВО Российский университет дружбы народов им. Патриса ЛумумбыРоссияPirogov Russian National Research Medical University; Peoples' Friendship University of RussiaRussian FederationФГАОУ ВО Российский национальный исследовательский медицинский университет им. Н. И. Пирогова Минздрава РоссиРоссияPirogov Russian National Research Medical UniversityRussian Federation20242708202429759155915Copyright © Ларина В.Н., Кокорин В.А., Лунев В.И., Суворова Н.А., 20242024Ларина В.Н., Кокорин В.А., Лунев В.И., Суворова Н.А.Larina V.N., Kokorin V.A., Lunev V.I., Suvorova N.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/5915

В статье обсуждается адаптация клинических рекомендаций Европейской федерации внутренней медицины по ведению пациентов с острой сердечной недостаточностью (ОСН). Предложен алгоритм дифференциально-диагностического обследования пациентов с ОСН и острой одышкой, признаками застоя, гипоксемией, включающий определение натрийуретических пептидов и/или сердечного тропонина, оценку выраженности застойных явлений методом эхокардиографии, а также возможность проведения рентгенографии органов грудной клетки и ультразвукового исследования легких в определенных клинических ситуациях. Отдельное внимание уделено методам оценки и лечения признаков застоя жидкости, обладающим наиболее точным прогностическим значением у госпитализированных вследствие ОСН пациентов. Освещены особенности оценки прогноза и необходимости госпитализации пациентов с ОСН в отделение интенсивной терапии. Разбираются стратегии лечения пациентов с артериальной гипотонией и низким сердечным выбросом. Представлены новейшие рекомендации по лечению пациентов с ОСН с учетом сопутствующей патологии. Обсуждаются показания к выписке пациентов с ОСН из стационара, оптимизация дальнейшего плана лечения, эффективные стратегии снижения риска регоспитализации и летальности, как на момент выписки из стационара, так и на амбулаторном этапе.

The article discusses the adaptation of European Federation of Internal Medicine clinical guidelines for the management of patients with acute heart failure (AHF). An algorithm has been proposed for the differential diagnostic examination of patients with AHF and acute shortness of breath, signs of congestion, hypoxemia, including the determination of natriuretic peptides (NUPs) and/or cardiac troponin, assessment of the congestion severity using echocardiography, as well as the potential of chest radiography and lung ultrasound in certain clinical situations. Special attention is paid to methods for assessing and treating signs of fluid congestion, which have the most accurate prognostic value in patients hospitalized due to AHF. Assessment of the prognosis and the need for hospitalization of AHF patients in the intensive care unit are highlighted. Treatment strategies for patients with hypotension and low cardiac output are discussed. The latest guidelines for the treatment of patients with AHF, taking into account concomitant diseases, are presented. Indications for hospital discharge of patients with AHF, optimization of the further treatment plan, effective strategies for reducing the risk of rehospitalization and mortality, both at the hospital discharge and outpatient stage, are discussed.

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The authors declare that there are no conflicts of interest present.