Review and adaptation of European Federation of Internal Medicine clinical guidelines on acute heart failure
https://doi.org/10.15829/15604071-2024-5915
EDN: SVTBVP
Abstract
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.
About the Authors
V. N. Larina
Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
MD, PhD, D.Sc. (Medicine), Professor, Head of Department of Outpatient Medicine of Faculty of General Medicine.
Moscow
Competing Interests:
the authors declare they have no conflict of interest
V. A. Kokorin
Pirogov Russian National Research Medical University; Peoples' Friendship University of Russia
Russian Federation
Competing Interests:
Russian Federation
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
Competing Interests:
the authors declare they have no conflict of interest.
V. I. Lunev
Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
MD, PhD, Assistant Professor of department of Outpatient Medicine of Faculty of General Medicine.
Moscow
Competing Interests:
the authors declare they have no conflict of interest.
N. A. Suvorova
Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
MD, PhD, assistant at the Department of hospital therapy named after academician P.E. Lukomsky.
Moscow
Competing Interests:
the authors declare they have no conflict of interest.
References
1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599726. doi:10.1093/eurheartj/ehab368.
2. Arrigo M, Jessup M, Mullens W, et al. Acute heart failure. Nat Rev Dis Primers. 2020; 6(1):16. doi:10.1038/s4157202001517.
3. Leśniak W, Morbidoni L, Dicker D, et al. Clinical practice guidelines adaptation for internists — An EFIM methodology. Eur J Intern Med. 2020;77:15. doi:10.1016/j.ejim.2020.05.016.
4. Sephien A, Dayto DC, Reljic T, et al. A Systematic Critical Appraisal of Clinical Practice Guidelines in Heart Failure Using the AGREE II Tool. Am J Cardiol. 2023;202:1928. doi:10.1016/j.amjcard.2023.06.052.
5. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6): 776803. doi:10.1016/j.jacc.2017.04.025.
6. National Institute for Health and Care Excellence Chronic heart failure in adults: diagnosis and management NG106. 2018. https://www.nice.org.uk/guidance/ng106. ISBN: 9781473130937.
7. Shoemaker MJ, Dias KJ, Lefebvre KM, et al. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Phys Ther. 2020;100(1):1443. doi:10.1093/ptj/pzz127.
8. McDonald M, Virani S, Chan M, et al. CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction. Can J Cardiol. 2021;37(4):53146. doi:10.1016/j.cjca.2021.01.017.
9. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895e1032. doi:10.1161/CIR.0000000000001063.
10. McDonagh TA, Metra M, Adamo M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):362739. doi:10.1093/eurheartj/ehad195.
11. Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al. Appropriate Use of Pointof-Care Ultrasonography in Patients With Acute Dyspnea in Emergency Department or Inpatient Settings: A Clinical Guideline From the American College of Physicians. Ann Intern Med. 2021;174(7):98593. doi:10.7326/M207844.
12. Kokorin VA, González-Franco A, Cittadini A, et al. Acute heart failure — an EFIM guideline critical appraisal and adaptation for internists. Eur J Intern Med. 2024:S09536205(24)000839. doi:10.1016/j.ejim.2024.02.028.
13. Bayes-Genis A, Docherty KF, Petrie MC, et al. Practical algorithms for early diagnosis of heart failure and heart stress using NTproBNP: A clinical consensus statement from the Heart Failure Association of the ESC. Eur J Heart Fail. 2023;25(11):18918. doi:10.1002/ejhf.3036.
14. Lourenço P, Cunha FM, Elias C, et al. CA125 variation in acute heart failure: a single-centre analysis. ESC Heart Fail. 2022;9(2):101826. doi:10.1002/ehf2.13758.
15. Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney Dis. 2021;28(3):25261. doi:10.1053/j.ackd.2021.03.004.
16. Sun RR, Lu L, Liu M, et al. Biomarkers and heart disease. Eur Rev Med Pharmacol Sci. 2014;18(19):292735.
17. Köktürk U, Püşüroğlu H, Somuncu MU, et al. Short and Long-Term Prognostic Significance of Galectin3 in Patients with STElevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2023;74(9):88996. doi:10.1177/00033197221149846.
18. Larina VN, Lunev VI. The Value of Biomarkers in the Diagnosis and Prognosis of Heart Failure in Older Age. The Russian Archives of Internal Medicine. 2021;11(2):98110. (In Russ.) doi:10.20514/22266704202111298110.
19. Donirova OS, Protasov KV, Donirov BA, et al. Role of soluble ST2 in shortterm prediction of acute heart failure in acute STelevation myocardial infarction. Russian Journal of Cardiology. 2021;26(4):4308. (In Russ.) doi:10.15829/1560407120214308.
20. Aleksova A, Paldino A, Beltrami AP, et al. Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome There is Meat on the Bone. J Clin Med. 2019;8(2):270. doi:10.3390/jcm8020270.
21. Chen H, Chen C, Fang J, et al. Circulating galectin3 on admission and prognosis in acute heart failure patients: a metaanalysis. Heart Fail Rev. 2020;25(2):33141. doi:10.1007/s10741019098582.
22. Schrage B, Dabboura S, Yan I, et al. Application of the SCAI classification in a cohort of patients with cardiogenic shock. Catheter Cardiovasc Interv. 2020;96(3):E213E219. doi:10.1002/ccd.28707.
23. Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheter Cardiovasc Interv. 2019;94(1):2937. doi:10.1002/ccd.28329.
24. Kobalava ZhD, Safarova AF, Soloveva AE, et al. Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, inhospital changes, prognostic value. Kardiologiia. 2019;59(8):514. (In Russ.) doi:10.18087/cardio.2019.8.n534.
25. Boorsma EM, Ter Maaten JM, Damman K, et al. Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol. 2020;17(10): 64155. doi:10.1038/s4156902003797.
26. Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol. 2017;14(1):308. doi:10.1038/nrcardio.2016.163.
27. Wittczak A, Ślot M, Bielecka-Dabrowa A. The Importance of Optimal Hydration in Patients with Heart Failure-Not Always Too Much Fluid. Biomedicines. 2023;11(10):2684. doi:10.3390/biomedicines11102684.
28. Mareev VY, Garganeeva AA, Ageev FT, et al. The use of diuretics in chronic heart failure. Position paper of the Russian Heart Failure Society. Kardiologiia. 2020;60(12):1347. (In Russ.) doi:10.18087/cardio.2020.12.n1427.
29. Metra M, Tomasoni D, Adamo M, et al. Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2023;25(6):77691. doi:10.1002/ejhf.2874.
30. Kobalava ZhD, Tolkacheva VV, Sarlykov BK, et al. Integral assessment of congestion in patients with acute decompensated heart failure. Russian Journal of Cardiology. 2022;27(2):4799. (In Russ.) doi:10.15829/1560407120224799.
31. Zhirov IV, Nasonova SN, Syrkhaeva AA, et al. Optimization of intravascular volume determination in patients with acute decompensated heart failure. Russian Journal of Cardiology. 2022;27(5):5039. (In Russ.) doi:10.15829/1560407120225039.
32. Crespo-Leiro MG, Metra M, Lund LH, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20(11):150535. doi:10.1002/ejhf.1236.
33. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):9931004. doi:10.1056/NEJMoa1409077.
34. Maack C, Eschenhagen T, Hamdani N, et al. Treatments targeting inotropy. Eur Heart J. 2019;40(44):362644. doi:10.1093/eurheartj/ehy600.
35. Chioncel O, Mebazaa A, Maggioni AP, et al. Acute heart failure congestion and perfusion status -impact of the clinical classification on inhospital and longterm outcomes; insights from the ESCEORPHFA Heart Failure Long-Term Registry. Eur J Heart Fail. 2019;21(11):133852. doi:10.1002/ejhf.1492.
36. Ceriani E, Casazza G, Peta J, et al. Residual congestion and longterm prognosis in acutely decompensated heart failure patients. Intern Emerg Med. 2020;15(4):71924. doi:10.1007/s1173902002326y.
37. Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of uptitration of guideline-directed medical therapies for acute heart failure (STRONGHF): a multinational, openlabel, randomised, trial. Lancet. 2022;400(10367):193852. doi:10.1016/S01406736(22)020761.
38. Vaduganathan M, Docherty KF, Claggett BL, et al. SGLT2 inhibitors in patients with heart failure: a comprehensive metaanalysis of five randomised controlled trials. Lancet. 2022;400(10354):75767. doi:10.1016/S01406736(22)014295.
39. Tromp J, Ponikowski P, Salsali A, et al. Sodium-glucose cotransporter 2 inhibition in patients hospitalized for acute decompensated heart failure: rationale for and design of the EMPULSE trial. Eur J Heart Fail. 2021;23(5):82634. doi:10.1002/ejhf.2137.
40. Packer M. Acute Heart Failure Is an Event Rather Than a Disease: Plea for a Radical Change in Thinking and in Therapeutic Drug Development. JACC Heart Fail. 2018;6(1):735. doi:10.1016/j.jchf.2017.05.008.
41. Wand AL, Russell SD, Gilotra NA. Ambulatory Management of Worsening Heart Failure: Current Strategies and Future Directions. Heart Int. 2021;15(1):4953. doi:10.17925/ HI.2021.15.1.49.
42. Serrano JAM, López JAC, Mendoza AC, et al. Vulnerable period in heart failure: a window of opportunity for the optimization of treatment — a statement by Mexican experts. Drugs Context. 2024;13:202381. doi:10.7573/dic.202381.
43. Chioncel O, Collins SP, Ambrosy AP, et al. Improving Postdischarge Outcomes in Acute Heart Failure. Am J Ther. 2018;25(4):e475e486. doi:10.1097/MJT.0000000000000791.
44. Maddox TM, Januzzi JL Jr, Allen LA, et al. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2024;83(15):144488. doi:10.1016/j.jacc.2023.12.024.
45. Theofilis P, Oikonomou E, Tsioufis K, et al. Diabetes Mellitus and Heart Failure: Epidemiology, Pathophysiologic Mechanisms, and the Role of SGLT2 Inhibitors. Life (Basel). 2023;13(2):497. doi:10.3390/life13020497.
Supplementary files
Review
For citations:
Larina V.N., Kokorin V.A., Lunev V.I., Suvorova N.A. Review and adaptation of European Federation of Internal Medicine clinical guidelines on acute heart failure. Russian Journal of Cardiology. 2024;29(7):5915. (In Russ.) https://doi.org/10.15829/15604071-2024-5915. EDN: SVTBVP
Views:
973
Email this article 