Acutely decompensated versus acute heart failure: two different entities
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Acutely decompensated versus acute heart failure: two different entities Andrew Xanthopoulos 1 & Javed Butler 2 & John Parissis 3 & Eftihia Polyzogopoulou 4 & John Skoularigis 1 & Filippos Triposkiadis 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Heart failure (HF) has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention. However, ADCHF and de novo AHF have fundamental pathophysiological differences. Most importantly, the typical illness trajectory of HF, which is similar to that of other chronic organ diseases including lung, renal, and liver failure, features a gradual decline, with acute episodes usually related to disease evolution followed by partial recovery. Thus, ADCHF should be considered part of the natural history of CHF and renamed CHF exacerbation (CHFE) in accordance with the appropriate terminology used in chronic obstructive pulmonary disease. AHF, in turn, should include only acute de novo HF. The clinical implications of this paradigm shift will be in CHFE the change in focus from in-hospital to optimal ambulatory CHF management aiming at primary and secondary CHFE prevention, while in AHF, the institution of measures for in-hospital limitation of cardiac injury and prevention or retardation of symptomatic CHF development. Keywords Acutely decompensated chronic HF . Exacerbation . Classification . Chronic
Introduction Based on the traditional perspective, HF has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been increasingly recognized as a distinct disorder and subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention [1, 2].
In this manuscript, we contend that ADCHF is an integral part in the natural history of CHF and should not be considered a subdivision of AHF. In this regard, we summarize the differences in the characteristics between ADCHF and de novo AHF and emphasize the similarities between the natural history of CHF with that of other chronic organ diseases. Finally, we propose a new classification of HF requiring hospital management based on the underlying pathophysiology.
Differences between ADCHF and de novo AHF * Filippos Triposkiadis [email protected] 1
Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10 Larissa, Greece
2
Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
3
Heart Failure Unit, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
4
Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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