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The Benefits of Early Vasoactive Therapy in the Treatment of Acute Decompensated Heart Failure

Authors

  • Nancy M. Albert PhD, CCNS, CCRN, CNA

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      Author
      Nancy Albert, PhD, CCNS, CCRN, CNA, is Director of Nursing Research and Innovation-Divison of Nursing and Clinical Nurse Specialist at the George M. and Linda H. Kaufman Center for Heart Failure of the Cleveland Clinic, Ohio.


  • Acknowledgment
    This study was supported by an unrestricted educational grant from Scios, Inc., manufacturer of nesiritide.

Contact Dr. Albert by e-mail at albertn@ccf.org

Abstract

Purpose

To review current issues in the management of acute decompensated heart failure (ADHF), focusing on the early initiation of intravenous (i.v.) vasoactive therapy and including the effects of vasoactive drugs on patient outcomes and the benefits and limitations of each medication class.

Data sources

Review of the worldwide scientific literature on ADHF.

Conclusions

The management of ADHF may be improved by early initiation of i.v. vasoactive therapy, reduced use of inotropic agents, and judicious use of diuretics. Data to date suggest that early treatment with the natriuretic peptide nesiritide reduces duration of hospitalization, in-hospital mortality, and requirements for i.v. inotropes and diuretics.

Implications for practice

Advance practice nurses play an integral role in the management of patients with ADHF from initial triage in the emergency department through final discharge from the hospital. Because they are typically responsible for administering medications and monitoring patient status, nurses need to be familiar with the benefits and limitations of each class of vasoactive agent. They need to recognize that prompt initiation of i.v. vasodilator therapy is important for improving patient outcomes. Further, advance practice nurses should participate in team management that promotes the use of evidence-based ADHF care by developing, using, and assertively communicating the need for processes of care that facilitate best practices.

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