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Acute heart failure

Nature Reviews Disease Primers volume 6, Article number: 16 (2020) Cite this article

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Abstract

Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome. Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities. As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.

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Fig. 1: Schematic representation of possible pathophysiological mechanisms in AHF.
Fig. 2: Proposed management algorithm for patients with AHF.
Fig. 3: Quality of life in patients with AHF.

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Acknowledgements

N.R. is supported by the National Institutes of Health, National Human Genome Research Institute, Ruth L. Kirschstein Institutional National Research Service T32 Award in Genomic Medicine (T32 HG009495).

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Authors and Affiliations

  1. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland

    Mattia Arrigo

  2. Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Mariell Jessup & Nosheen Reza

  3. Ziekenhuis Oost Limburg, Genk, Belgium

    Wilfried Mullens

  4. University of Hasselt, Hasselt, Belgium

    Wilfried Mullens

  5. School of Cardiovascular Medicine & Sciences, King’s College London British Heart Foundation Centre, London, UK

    Ajay M. Shah

  6. Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Department of Medicine and Cardiology, University of Cape Town, Cape Town, South Africa

    Karen Sliwa

  7. Université de Paris, MASCOT, Inserm, Paris, France

    Alexandre Mebazaa

  8. Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France

    Alexandre Mebazaa

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  1. Mattia Arrigo
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  2. Mariell Jessup
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  3. Wilfried Mullens
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  4. Nosheen Reza
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  5. Ajay M. Shah
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  6. Karen Sliwa
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  7. Alexandre Mebazaa
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Contributions

Introduction (A.M. and M.A.); Epidemiology (K.S.); Mechanisms/pathophysiology (M.A., W.M. and A.M.S.); Diagnosis, screening and prevention (A.M. and M.A.); Management (M.J., W.M. and N.R.); Quality of life (M.J. and N.R.); Outlook (A.M.); Overview of Primer (A.M.).

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Correspondence to Alexandre Mebazaa.

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Nature Reviews Disease Primers thanks A. Palazzuoli and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Arrigo, M., Jessup, M., Mullens, W. et al. Acute heart failure. Nat Rev Dis Primers 6, 16 (2020). https://doi.org/10.1038/s41572-020-0151-7

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