Division of Cardiology, School of Medicine, University of California San Francisco (J.N.N., J.R.T.), San Francisco, CA.
Section of Cardiology, San Francisco Veterans Affairs Medical Center (J.R.T.), San Francisco, CA.
Circ Res. 2021 May 14;128(10):1468-1486. doi: 10.1161/CIRCRESAHA.121.318186. Epub 2021 May 13.
Acute decompensated heart failure (ADHF) is one of the leading admission diagnoses worldwide, yet it is an entity with incompletely understood pathophysiology and limited therapeutic options. Patients admitted for ADHF have high in-hospital morbidity and mortality, as well as frequent rehospitalizations and subsequent cardiovascular death. This devastating clinical course is partly due to suboptimal medical management of ADHF with persistent congestion upon hospital discharge and inadequate predischarge initiation of life-saving guideline-directed therapies. While new drugs for the treatment of chronic HF continue to be approved, there has been no new therapy approved for ADHF in decades. This review will focus on the current limited understanding of ADHF pathophysiology, possible therapeutic targets, and current limitations in expanding available therapies in light of the unmet need among these high-risk patients.
急性失代偿性心力衰竭（ADHF）是全球主要的入院诊断之一，但它是一种发病机制尚未完全阐明且治疗选择有限的病症。因 ADHF 入院的患者住院期间发病率和死亡率较高，且频繁再次入院和随后发生心血管死亡。这种灾难性的临床病程部分归因于 ADHF 的医疗管理不理想，出院时仍存在充血以及救生指南导向治疗的出院前启动不充分。虽然用于治疗慢性 HF 的新药不断获得批准，但数十年来，ADHF 仍没有新的治疗方法获得批准。本综述将重点关注目前对 ADHF 发病机制的有限认识、可能的治疗靶点以及在这些高危患者存在未满足需求的情况下扩大现有治疗方法的局限性。
