Acute Decompensated Heart Failure
The history of a patient with congestive/chronic heart failure is often marked by a steady, gradual decline in heart function punctuated by intermittent, severe deteriorations that frequently require hospitalization. The risk of acute exacerbations (i.e. acute decompensated heart failure [ADHF]) increases as the patient's baseline congestive heart failure worsens. Episodes of ADHF are marked by a severe diminution of cardiac function that typically results in fluid accumulation in the lungs (pulmonary edema) and consequent severe shortness of breath. These symptoms typically prompt a visit to the emergency room and frequently result in hospitalization. Acute heart failure can result from a variety of factors including lack of compliance with medications or diet, cardiac events (i.e. acute myocardial infarct, cardiac arrhythmias, uncontrolled hypertension, valvular heart disease), acute non-cardiac events (i.e. pulmonary embolus, anemia, systemic infection, thyroid disorders, rheumatologic disease) or the effects of other drugs.
ADHF is the leading diagnosis at the time of discharge from U.S. hospitals and is the most common cause of hospitalization for patients over 65 years of age. There were 1.1 million hospitalizations for acute heart failure in the US in 2006. ADHF is a deadly condition, with in hospital mortality rates of 2-6% and six month readmission rates as high as 30-60%. Among patients hospitalized with ADHF, the thirty day mortality rate is approximately 11% and the one year mortality rate is 34%. These poor outcomes indicate the clear need for better therapies to treat this patient population.
Heart Disease and Stroke Statistics 2009 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119:e1-e161
Gheorghiade, M. Reassessing treatment of acute heart failure syndromes: the ADHERE Registry. European Heart Journal Supplements (2005) 7 (Supplement B), B13-B19
Jong, P et al. Prognosis and Determinants of Survival in Patients Newly Hospitalized for Heart Failure. Arch Int Med, 162:1689