Περίληψη:
Patients with acute heart failure (AHF) require urgent in-hospital
treatment for relief of symptoms. The main reason for hospitalization is
congestion, rather than low cardiac output. Although congestion is
associated with a poor prognosis, many patients are discharged with
persistent signs and symptoms of congestion and/or a high left
ventricular filling pressure. Available data suggest that a
pre-discharge clinical assessment of congestion is often not performed,
and even when it is performed, it is not done systematically because no
method to assess congestion prior to discharge has been validated.
Grading congestion would be helpful for initiating and following
response to therapy. We have reviewed a variety of strategies to assess
congestion which should be considered in the care of patients admitted
with HF. We propose a combination of available measurements of
congestion. Key elements in the measurement of congestion include
bedside assessment, laboratory analysis, and dynamic manoeuvres. These
strategies expand by suggesting a routine assessment of congestion and a
pre-discharge scoring system. A point system is used to quantify the
degree of congestion. This score offers a new instrument to direct both
current and investigational therapies designed to optimize volume status
during and after hospitalization. In conclusion, this document reviews
the available methods of evaluating congestion, provides suggestions on
how to properly perform these measurements, and proposes a method to
quantify the amount of congestion present.
Συγγραφείς:
Gheorghiade, Mihai
Follath, Ferenc
Ponikowski, Piotr
Barsuk,
Jeffrey H.
Blair, John E. A.
Cleland, John G.
Dickstein,
Kenneth
Drazner, Mark H.
Fonarow, Gregg C.
Jaarsma, Tiny and
Jondeau, Guillaume
Lopez Sendon, Jose
Mebazaa, Alexander and
Metra, Marco
Nieminen, Markku
Pang, Peter S.
Seferovic,
Petar
Stevenson, Lynne W.
van Veldhuisen, Dirk J.
Zannad,
Faiez
Anker, Stefan D.
Rhodes, Andrew
McMurray, John J. V.
and Filippatos, Gerasimos
