Guidelines for the Management of Heart Failure

October 30, 2013 by  
Filed under Acute Med, All Updates, EMS, Guidelines, ICU, Resus

Some new guidelines to be aware of are the AHA Guidelines for the Management of Heart Failure. Full text is available free and while comprehensively covering chronic heart failure there is an interesting section on acute decompensated heart failure.

Evidence-based medicine enthusiasts might be interested in recommendations to consider dopamine, nesiritide, and ultrafiltration. These therapies also get a mention in the 2012 European Guidelines. I recommend you review the articles cited in the guidelines to make your own mind up.

Here are a couple of snippets you may find useful:


Snippet from American Guidelines: intravenous loop diuretic doses

“HF patients receiving loop diuretic therapy should receive an initial parenteral dose greater than or equal to their chronic oral daily dose; then dose should be serially adjusted.”


Snippet from European Guidelines: management algorithm for acute heart failure

Click to enlarge

AHF-ESC

2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary
Circulation. 2013 Oct 15;128(16):1810-52 Free Full Text

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
Eur Heart J. 2012 Jul;33(14):1787-847 Free Full Text

Comments

2 Responses to “Guidelines for the Management of Heart Failure”

  1. Seth Trueger on October 30th, 2013 08:11

    Note the immediately preceding snippet:
    “Patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to reduce morbidity.310,311 (Level of Evidence: B)”

    1) evidence of significant fluid overload

    2) “promptly”

    Works well with my current framework of no loop diuretics until I have a creatinine back — my creatinine level is “stat” — which beats “promptly”!

  2. John Shirley on November 3rd, 2013 21:45

    All such patients with acute LHF need an urgent bedside echo to establish the cause of their heart failure. This should be part of their ED work-up. Treatment of incompetent mitral valve is going to be different to dilated cardiomyopathy or cardiac tamponade.