Management Strategies for Stage-D Patients with Acute Heart Failure
Article first published online: 23 OCT 2007
Copyright © 2007 Wiley Periodicals, Inc.
Volume 31, Issue 7, pages 297–301, July 2008
How to Cite
Feldman, D., Menachemi, D. M., Abraham, W. T. and Wexler, R. K. (2008), Management Strategies for Stage-D Patients with Acute Heart Failure. Clin Cardiol, 31: 297–301. doi: 10.1002/clc.20251
- Issue published online: 17 JUL 2008
- Article first published online: 23 OCT 2007
- Manuscript Accepted: 16 JUL 2007
- Manuscript Received: 31 MAY 2007
- heart failure;
- cardiac transplantation;
Heart Failure (HF) accounted for 3.4 million ambulatory visits in 2000. Current guidelines from the American Heart Association/American College of Cardiology, the Heart Failure Society of America, and the International Society for Heart & Lung Transplantation recommend aggressive pharmacologic interventions for patients with HF. This may include a combination of diuretics, Angiotensin Converting Enzyme inhibitors, β-blockers, angiotensin receptor blockers, aldosterone antagonists, and digoxin. Nitrates and hydralazine are also indicated as part of standard therapy in addition to β-blockers and Angiotensin Converting Enzyme inhibitors, especially but not exclusively, for African Americans with left ventricular (LV) systolic dysfunction. For those with acute decompensated HF, additional treatment options include recombinant human B-type natriuretic peptide, and in the future possible newer agents not yet approved for use in the U.S., such as Levosimendan. Medical devices for use in patients with advanced HF include LV assist devices, cardiac resynchronization therapy, and implantable cardioverter defibrillators. For refractory patients, heart transplantation, the gold-standard surgical intervention for the treatment of refractory HF, may be considered. Newer surgical options such as surgical ventricular restoration may be considered in select patients. Copyright © 2007 Wiley Periodicals, Inc.