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Successful treatment for acute heart failure remains elusive

December 21, 2005

Heart failure experts publish consensus report in Circulation

In recent years, cardiologists have begun to view acute heart failure syndrome (AHFS) as a distinct condition, not merely a part of the chronic heart failure continuum. However, there is not yet a consensus on a definition, epidemiology, appropriate therapy and directions for future research for acute heart failure syndrome, says a Special Report published in today's Circulation journal. The report is the result of the First and Second International Workshops on Acute Heart Failure Syndrome that took place in May 2004 and April 2005.

"Although we've accomplished much in the management of chronic heart failure, the absence of evidence-based clinical practice guidelines for acute heart failure syndrome is striking," says the report's lead author, Mihai Gheorghiade, MD, associate chief, Division of Cardiology at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital. "I liken the current state of our understanding of acute heart failure to cardiologists understanding of heart attacks before 1980," says Dr. Gheorghiade. "Until then, we thought the clot was the result of the heart attack, not the cause, and so the clot was not being treated. In 2005, we're just at the point of looking for the 'clot' in acute heart failure - what causes it and how can we best treat it?"

Heart failure is the inability of the heart to supply adequate blood flow and therefore oxygen to peripheral tissues and organs and leads to over one million hospitalizations each year in the United States. "We've been successful in finding ways to treat chronic heart failure," says Dr. Gheorghiade. "And, on the surface it looks like we're successful at treating ACHF. Patients are treated, feel better and are discharged. The problem is that within 90 days of discharge, nearly 10 percent of patients die and about 30 percent are readmitted."

Traditionally, cardiologists have treated chronic heart failure and acute heart failure in the same fashion, says Dr. Gheorghiade. "Acute heart failure does not equal chronic heart failure. What's good for one may not be good for the other. For the last two years, every clinical trial with acute heart failure patients has been unsuccessful in improving mortality," says Dr. Gheorghiade

The report calls for a systematic research efforts on the clinical application and translation of promising basic science results and a focus on the choice of appropriate management strategies, including minimizing the use of drugs with adverse effects and development and validation of known prognostic markers to guide AHFS interventions.

The report also states that a significant number of AHFS patients are not being evaluated for potential beneficial surgical procedures that include myocardial revascularization, LV reconstruction, mitral valve surgery, or cardiac transplantation.

The workshops were attended by a selected group of physician scientists, epidemiologists, clinicians, regulatory and government funding agencies, and industry representatives from North and South America and Europe.

Northwestern Memorial Hospital