Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Can J Cardiol. 2021 Apr;37(4):621-631. doi: 10.1016/j.cjca.2021.01.002. Epub 2021 Jan 10.
Acute heart failure (AHF) is a complex, heterogeneous, clinical syndrome with high morbidity and mortality, incurring significant health care costs. Patients transition from home to the emergency department, the hospital, and home again and require decisions surrounding diagnosis, treatment, and prognosis at each step of the way. The purpose of this review is to examine the epidemiology, etiology, and classifications of AHF and specifically focus on practical information relevant to the clinician. We examine the mechanisms of decompensation relevant to clinical presentations-including precipitating factors, neuroendocrine interactions, and inflammation-along with how consideration of these factors may help select therapies for an individual patient. The prevalence and significance of end-organ manifestations such as renal, gastrointestinal, respiratory, and neurologic manifestations are discussed. We also highlight how the development of renal dysfunction relates to the choice of a variety of diuretics that may be useful in specific circumstances and review guideline-directed medical therapy. We discuss the practical use (and pitfalls) of a variety of evidence-based clinical scoring criteria available to risk stratify patients with AHF. Finally, evidence-based management of AHF is discussed, including both pharmacologic and nonpharmacologic therapies, including the lack of evidence for using old and new vasodilators and the recent evidence regarding initiation of newer therapies in hospital. Overall, we suggest that clinicians consider implementing the newer data in AHF and subject existing practice patterns and treatments to the same rigour as new therapies.
急性心力衰竭（AHF）是一种复杂的、异质的临床综合征，具有较高的发病率和死亡率，导致了大量的医疗保健费用。患者从家庭转移到急诊科、医院，然后再回到家庭，在每个阶段都需要围绕诊断、治疗和预后做出决策。本综述的目的是探讨 AHF 的流行病学、病因和分类，并特别关注与临床医生相关的实用信息。我们研究了与临床表现相关的失代偿机制，包括诱发因素、神经内分泌相互作用和炎症，以及考虑这些因素如何有助于为个体患者选择治疗方法。还讨论了终末器官表现（如肾脏、胃肠道、呼吸和神经表现）的患病率和意义。我们还强调了肾功能障碍的发展如何与各种利尿剂的选择相关，这些利尿剂在特定情况下可能有用，并回顾了指南指导的药物治疗。我们讨论了各种基于证据的临床评分标准的实际应用（和陷阱），这些标准可用于对 AHF 患者进行风险分层。最后，讨论了 AHF 的循证管理，包括药物和非药物治疗，包括使用旧的和新的血管扩张剂缺乏证据，以及最近关于在医院开始使用新疗法的证据。总的来说，我们建议临床医生考虑将新数据应用于 AHF，并对现有实践模式和治疗方法进行与新疗法相同的严格评估。
