Matassini Maria Vittoria, Manca Paolo, Limonta Raul, Marini Marco, Orso Francesco, Carigi Samuela, Di Nora Concetta, De Gennaro Luisa, Tinti Maria Denitza, Bianco Matteo, Rizzello Vittoria, Palmieri Vittorio, De Maria Renata, Iacovoni Attilio, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio, Gori Mauro
S.O.D. Cardiologia-UTIC, A.O.U. delle Marche, Ancona.
Cardiologia Clinica e dell'Insufficienza Cardiaca, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, ISMETT IRCCS, Palermo.
G Ital Cardiol (Rome). 2025 Mar;26(3):173-184. doi: 10.1714/4454.44486.
Heart failure (HF) is a clinical syndrome with high morbidity and mortality, characterized by periods of relative clinical stability and exacerbations of HF, known as worsening heart failure (WHF). WHF is currently defined as a deterioration of HF signs and symptoms, necessitating an intensification of medical therapy, often identified by an increase in diuretic therapy. Episodes of WHF, whether they result in patient hospitalization or outpatient management, suggest clinical progression of HF with significant worsening of the prognosis. Although the prognostic impact of WHF is well documented in the literature, its current definition has limitations, and its management remains suboptimal and non-standardized, particularly in outpatient settings. Additionally, early detection of WHF episodes, preventing possible patient hospitalization, is crucial for improving prognosis and is still underemphasized in major HF clinical trials. This review aims to report the prevalence of WHF and the limitations of its current definition, and to provide suggestions for the appropriate management of WHF episodes, with a special focus on early and outpatient recognition.
心力衰竭（HF）是一种发病率和死亡率都很高的临床综合征，其特征是存在相对临床稳定期和心力衰竭加重期，即所谓的心力衰竭恶化（WHF）。目前，WHF被定义为HF体征和症状的恶化，需要强化药物治疗，通常通过增加利尿剂治疗来确定。WHF发作，无论导致患者住院还是门诊治疗，都提示HF临床进展且预后显著恶化。尽管WHF对预后的影响在文献中有充分记载，但其当前定义存在局限性，其管理仍不理想且不规范，尤其是在门诊环境中。此外，早期发现WHF发作、预防患者可能住院，对于改善预后至关重要，但在主要的HF临床试验中仍未得到充分重视。本综述旨在报告WHF的患病率及其当前定义的局限性，并为WHF发作的适当管理提供建议，特别关注早期和门诊识别。
