Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 45; no. S1; pp. S40 - S51
• Main Authors: Ostrominski, John W., Vaduganathan, Muthiah
• Format: Journal Article
• Language: English
• Published: Hoboken John Wiley & Sons, Inc 01.06.2022; John Wiley and Sons Inc
• Subjects: acute heart failure; Cardiovascular disease; Clinical trials; Diuretics; Drug therapy; Edema; Ejection fraction; Evidence-based medicine; Expenditures; guideline‐directed medical therapy; Health aspects; Heart; Heart failure; heart failure hospitalization; Hemodynamics; Hospitalization; Invited Review; Medical care, Cost of; Mortality; Patients; Publication of this special issue was made possible by AstraZeneca; quadruple therapy; registries; Valsartan; Ventilators; worsening heart failure
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23849

Heart failure (HF) is a chronic, progressive, and increasingly prevalent syndrome characterized by stepwise declines in health status and residual lifespan. Despite significant advancements in both pharmacologic and nonpharmacologic management approaches for chronic HF, the burden of HF hospitalization—whether attributable to new‐onset (de novo) HF or worsening of established HF—remains high and contributes to excess HF‐related morbidity, mortality, and healthcare expenditures. Owing to a paucity of evidence to guide tailored interventions in this heterogeneous group, management of acute HF events remains largely subject to clinician discretion, relying principally on alleviation of clinical congestion, as‐needed correction of hemodynamic perturbations, and concomitant reversal of underlying trigger(s). Following acute stabilization, the subsequent phase of care primarily involves interventions known to improve long‐term outcomes and rehospitalization risk, including initiation and optimization of disease‐modifying pharmacotherapy, targeted use of adjunctive therapies, and attention to contributing comorbid conditions. However, even with current standards of care many patients experience recurrent HF hospitalization, or after admission incur worsening clinical trajectories. These patterns highlight a persistent unmet need for evidence‐based approaches to inform in‐hospital HF care and call for renewed focus on urgent implementation of interventions capable of ameliorating risk of worsening HF. In this review, we discuss key contemporary and emerging therapeutic strategies for patients hospitalized with de novo or worsening HF.