Circulation. 2005;112:3958-3968
doi: 10.1161/CIRCULATIONAHA.105.590091
doi: 10.1161/CIRCULATIONAHA.105.590091
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(Circulation. 2005;112:3958-3968.)
© 2005 American Heart Association, Inc.
Special Report |
Acute Heart Failure Syndromes
Current State and Framework for Future Research
From the Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.G., L.K.); INSERM-CHU Nancy, Dommartin-lès-Toul, France (F.Z.); the National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.); University Hospital of Cleveland, Cleveland, Ohio (I.L.P.); New England Medical Center, Boston, Mass (M.A.K.); Veterans Affairs Medical Center, San Francisco, Calif (B.M.); Agence Française de Securité Sanitaire Produits de Santé, Paris, France (E.R.); Food and Drug Administration, Rockville, Md (S.T.); University of Cincinnati, Cincinnati, Ohio (S.P.C.); University of Athens Hospital Attikon, Athens, Greece (G.F.); and IRCCS Policlinico San Matteo, Pavia, Italy (L.T.).
Correspondence to Mihai Gheorghiade, MD, Division of Cardiology, Northwestern University Feinberg School of Medicine, Galter 10-240, 201 E Huron St, Chicago, IL 60611. E-mail m-gheorghiade@northwestern.edu
Key Words: heart failure • coronary disease • morbidity • mortality
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Acute heart failure syndromes (AHFS) poses unique diagnostic and management challenges. This syndrome has recently received attention from researchers, clinicians, regulatory agencies, and the pharmaceutical industry. However, there is no consensus on its definition, epidemiology, pathophysiology, appropriate therapeutic options, and directions for future research.
This document is the result of the First and Second International Workshop on Acute Heart Failure Syndrome that took place in May 2004 and April 2005. At these workshops, a selected group of physician scientists, epidemiologists, clinicians, regulatory and governmental funding agencies, and industry representatives from North and South America and Europe convened to develop a platform for future investigative approaches and management of AHFS. Subsequently, emergency physicians, who play a pivotal role in the early management of AHFS, contributed to this document.
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Definition |
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AHFS is defined as gradual or rapid change in heart failure (HF) signs and symptoms resulting in a need for urgent therapy. These symptoms are primarily the result of severe pulmonary congestion due to elevated left ventricular (LV) filling pressures (with or without low cardiac output). AHFS can occur in patients with preserved or reduced ejection fraction (EF). Concurrent cardiovascular conditions such as coronary heart disease (CHD), hypertension, valvular heart disease, atrial arrhythmias, and/or noncardiac conditions (including renal dysfunction, diabetes, anemia) are often present and may precipitate or contribute to the pathophysiology of this syndrome.1–3
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Public Health Issues |
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HF hospitalizations have risen steadily, with >1 million in 2004 in the United States4; a similar number has been reported in Europe. In the United States, it
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|
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 D. Juric, P. Wojciechowski, D. K. Das, and T. Netticadan Prevention of concentric hypertrophy and diastolic impairment in aortic-banded rats treated with resveratrol Am J Physiol Heart Circ Physiol, May 1, 2007; 292(5): H2138 - H2143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 A. Ahmed Digoxin and Reduction in Mortality and Hospitalization in Geriatric Heart Failure: Importance of Low Doses and Low Serum Concentrations J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2007; 62(3): 323 - 329. [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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|
|
|
|
|
|
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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|
|
|
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M. Gheorghiade, D. J. van Veldhuisen, and W. S. Colucci Contemporary Use of Digoxin in the Management of Cardiovascular Disorders Circulation, May 30, 2006; 113(21): 2556 - 2564. [Full Text] [PDF]
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