Acute Heart Failure: Patient Characteristics and Pathophysiology
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EPIDEMIOLOGY OF HEART FAILURE (J BUTLER, SECTION EDITOR)
Acute Heart Failure: Patient Characteristics and Pathophysiology Catherine N. Marti & Vasiliki V. Georgiopoulou & Andreas P. Kalogeropoulos
# Springer Science+Business Media New York 2013
Abstract The number of hospitalizations for acute heart failure (HF) continues to increase and it remains the most common discharge diagnosis among Medicare beneficiaries. Prognosis after hospitalization for HF is poor, with high inhospital mortality and even higher post-discharge mortality and rehospitalization rates. It is a complex clinical syndrome that varies widely with respect to clinical presentation and underlying pathophysiology. This paper reviews what is documented in the literature regarding the known pathophysiologic mechanisms reported in patients hospitalized for HF. Keywords Heart failure . Hospitalization . Acute . Pathophysiology . Endothelial function
Introduction The importance of heart failure (HF) hospitalizations is well recognized. There are over a million hospitalizations for HF annually in the United States, and they represent a turning point in the natural history of HF, with a combined mortality and readmission rate of 30 % within 90 days of discharge; a quarter of patients are readmitted within 30 days and 30 % die within a year of hospitalization [1]. Hospitalizations are responsible for the majority of the $39 billion spent annually for
Funding Source This study was supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. C. N. Marti : V. V. Georgiopoulou : A. P. Kalogeropoulos Division of Cardiology, Emory University, Atlanta, GA, USA A. P. Kalogeropoulos (*) Emory Clinical Cardiovascular Institute, 1462 Clifton Road NE, Suite 535B, Atlanta, GA 30322, USA e-mail: [email protected]
HF care [1]. Over the last decade, many therapies have been evaluated in patients hospitalized for HF, with hundreds of millions of dollars invested. Despite positive signals in Phase II studies, none of these therapies have proven to reduce mortality or readmission rates [2•]. The reasons for this are multi-factorial, including drug effects, disease classification, patient selection, and trial conduct [3]. These hospitalizations represent a heterogeneous group of patients, the taxonomy is complex and remains without a consensus, and various terms have been used to describe the condition, including “acute HF“, “acute decompensated HF”, “acute HF syndromes”, and “hospitalized HF” [3–5]. Most studies have focused on treatment during the early phase of hospitalization for HF, and the interventions implemented were largely acute, in-hospital, short-term interventions. Interestingly, most of the deaths in these patients, even in the first 30 days, are not during the index hospitalization, but subsequent to discharge. There remains
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