Congestive heart failure AHA recommendations for hospitalized patient

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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
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Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
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Congestive heart failure end-of-life considerations

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Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2] Edzel Lorraine Co, D.M.D., M.D. [3]

2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2][3]

PATIENTS HOSPITALIZED WITH ACUTE DECOMPENSATED HF 2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2][3]

Assessment of Patients Hospitalized With Decompensated HF (DO NOT EDIT) [1][2][3]

Class I
"1. In patients hospitalized with HF, severity of congestion and adequacy of perfusion should be assessed to guide triage and initial therapy. [4] [5][6][7][8] (Level of Evidence: B-NR) "
"2. In patients hospitalized with HF, the common precipitating factors and the overall patient trajectory should be assessed to guide appropriate therapy. [8][9] (Level of Evidence: B-NR) "

Hospitalized Patients Presenting With Heart Failure (DO NOT EDIT) [1][2][3]

Class I
"1. The diagnosis of HF is primarily based on signs and symptoms derived from a thorough history and physical examination. Clinicians should determine the following:
a. Adequacy of systemic perfusion;
b. Volume status;
c. The contribution of precipitating factors and/or comorbidities;
d. If the HF is new onset or an exacerbation of chronic disease; and
e. Whether it is associated with preserved ejection fraction. "

" Chest radiographs, electrocardiogram, and echocardiography are key tests in this assessment. (Level of Evidence: C) "

"2. Measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) is useful to support clinical judgment for the diagnosis of acutely decompensated HF, especially in the setting of uncertainty for the diagnosis .[10][11][12](Level of Evidence: A) "
"3. Measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) and/or cardiac troponin is useful for establishing prognosis or disease severity in acutely decompensated HF.[13][14][15](Level of Evidence: A) "
"4. Acute coronary syndrome precipitating heart failure hospitalization should be promptly identified by electrocardiogram and cardiac troponin testing, and treated, as appropriate to the overall condition and prognosis of the patient. (Level of Evidence: C) "
"5. Common precipitating factors for acute HF should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy: (Level of Evidence: C) "
a. Nonadherence with medication regimen, sodium and/or fluid restriction;
b. Acute myocardial ischemia;
c. Uncorrected high blood pressure;
d. AF and other arrhythmias;
e. Recent addition of negative inotropic drugs (e.g., verapamil, nifedipine, diltiazem, beta blockers);
f. Pulmonary emboli;
g. Initiation of drugs that increase salt retention (e.g., steroids, thiazolidinediones, NSAIDs);
h. Excessive alcohol or illicit drug use;
i. Endocrine abnormalities (e.g., diabetes mellitus, hyperthyroidism, hypothyroidism) ;
j. Concurrent Infections (e.g., pneumonia, viral illnesses); and
k. Additional acute cardiovascular disorders (e.g., valve disease endocarditis, myopericarditis, aortic dissection)."
"6. Oxygen therapy should be administered to relieve symptoms related to hypoxemia. (Level of Evidence: C) "
"7. Whether the diagnosis of HF is new or chronic, patients who present with rapid decompensation and hypoperfusion associated with decreasing urine output and other manifestations of shock are critically ill and rapid intervention should be used to improve systemic perfusion. (Level of Evidence: C) "
"8. Patients admitted with HF and with evidence of significant fluid overload should be treated with intravenous loop diuretics. Therapy should begin in the emergency department or outpatient clinic without delay, as early intervention may be associated with better outcomes for patients hospitalized with decompensated HF. [16][17][18] (Level of Evidence: B) If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose. Urine output and signs and symptoms of congestion should be serially assessed, and diuretic dose should be titrated accordingly to relieve symptoms and to reduce extracellular fluid volume excess. (Level of Evidence: C) "
"9. Effect of HF treatment should be monitored with careful measurement of fluid intake and output; vital signs; body weight, determined at the same time each day; clinical signs (supine and standing) and symptoms of systemic perfusion and congestion. Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of IV diuretics or active titration of heart failure medications. (Level of Evidence: C) "
"10. In patients with clinical evidence of hypotension associated with hypoperfusion and obvious evidence of elevated cardiac filling pressures (e.g., elevated jugular venous pressure; elevated pulmonary artery wedge pressure), intravenous inotropic or vasopressor drugs should be administered to maintain systemic perfusion and preserve end organ performance while more definitive therapy is considered. (Level of Evidence: C) "
"11. Invasive hemodynamic monitoring should be performed to guide therapy in patients who are in respiratory distress or with clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment. (Level of Evidence: C) "
"12. In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT, it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications. [19][20][21] (Level of Evidence: C) "
"13. In patients with reduced ejection fraction experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with oral therapies known to improve outcomes, particularly ACE inhibitors or ARBs and beta blocker therapy, it is recommended that these therapies be continued in most patients in the absence of hemodynamic instability or contraindications. (Level of Evidence: C) "
"14. In patients hospitalized with HF with reduced ejection fraction not treated with oral therapies known to improve outcomes, particularly ACE inhibitors or ARBs and beta blocker therapy, initiation of these therapies is recommended in stable patients prior to hospital discharge. [19][20] (Level of Evidence: B) "
"15. Initiation of beta blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Particular caution should be used when initiating beta blockers in patients who have required inotropes during their hospital course. [19][20][21] (Level of Evidence: B) "
"16. In all patients hospitalized with HF, both with preserved and low ejection fraction, transition should be made from intravenous to oral diuretic therapy with careful attention to oral diuretic dosing and monitoring of electrolytes. With all medication changes, the patient should be monitored for supine and upright hypotension, worsening renal function and HF signs/symptoms. (Level of Evidence: C) "
"17. Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed:[22][23] [24][25](Level of Evidence: B)
a. Initiation of GDMT if not previously established and not contraindicated;
b. Precipitant causes of HF, barriers to optimal care transitions, and limitations in postdischarge support;
c. Assessment of volume status and supine/upright hypotension with adjustment of HF therapy as appropriate;
d. Titration and optimization of chronic oral HF therapy;
e. Assessment of renal function and electrolytes where appropriate;
f. Assessment and management of comorbid conditions;
g. Reinforcement of HF education, self-care, emergency plans, and need for adherence; and
h. Consideration for palliative care or hospice care in selected patients."
"18. Postdischarge systems of care, if available, should be used to facilitate the transition to effective outpatient care for patients hospitalized with HF. [26][23][27][28][29][30][31] (Level of Evidence: B) "
"19. A patient admitted to the hospital with decompensated HF should receive venous thromboembolism prophylaxis with an anticoagulant medication if the risk-benefit ratio is favorable.[32][33](Level of Evidence: B) "
"20. Multidisciplinary HF disease-management programs are recommended for patients at high risk for hospital readmission, to facilitate the implementation of GDMT, to address different barriers to behavioral change, and to reduce the risk of subsequent rehospitalization for HF.[26][29][34] (Level of Evidence: B) "
Class III (No Benefit)
"1. Use of parenteral inotropes in normotensive patients with acute decompensated HF without evidence of decreased organ perfusion is not recommended. [35] (Level of Evidence: B) "
"2. Routine use of invasive hemodynamic monitoring in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators is not recommended. [36] (Level of Evidence: B) "
Class IIa
"1. When patients present with acute HF and known or suspected acute myocardial ischemia due to occlusive coronary disease, especially when there are signs and symptoms of inadequate systemic perfusion, urgent cardiac catheterization and revascularization is reasonable where it is likely to prolong meaningful survival. (Level of Evidence: C) "
"2. Invasive hemodynamic monitoring can be useful for carefully selected patients with acute heart failure who have persistent symptoms despite empiric adjustment of standard therapies, and (Level of Evidence: C) "
a. Whose fluid status, perfusion, or systemic or pulmonary vascular resistances are uncertain,
b. Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy,
c. Whose renal function is worsening with therapy
d. Who require parenteral vasoactive agents or
e. Who may need consideration for advanced device therapy or transplantation.
"3. Ultrafiltration is reasonable for patients with refractory congestion not responding to medical therapy. [37] (Level of Evidence: B) "
"4. When diuresis is inadequate to relieve symptoms, it is reasonable to intensify the diuretic regimen using either: (Level of Evidence: B) "
a. Higher doses of loop diuretics.[38]; or
b. Addition of a second diuretic (e.g., thiazide).[39][40]
"5. Scheduling an early follow-up visit (within 7 to 14 days) and early telephone follow-up (within 3 days) of hospital discharge is reasonable.[41][42] (Level of Evidence: B) "
"6. Use of clinical risk-prediction tools and/or biomarkers to identify patients at higher risk for postdischarge clinical events is reasonable.[43] (Level of Evidence: B) "
Class IIb
"1. The usefulness of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy for acutely decompensated HF is not well established. (Level of Evidence: A) "
"2. Intravenous inotropic drugs such as dopamine, dobutamine or milrinone might be reasonable for those patients presenting with documented severe systolic dysfunction, low blood pressure and evidence of low cardiac output, with or without congestion, to maintain systemic perfusion and preserve end-organ performance. (Level of Evidence: C) "
"3. Low-dose dopamine infusion may be considered in addition to loop diuretic therapy to improve diuresis and better preserve renal function and renal blood flow.[44][45] (Level of Evidence: B) "
"4. Ultrafiltration may be considered for patients with obvious volume overload to alleviate congestive symptoms and fluid weight.[37] (Level of Evidence: B) "
"5. Ultrafiltration may be considered for patients with refractory congestion not responding to medical therapy. (Level of Evidence: C) "
"6. If symptomatic hypotension is absent, intravenous nitroglycerin, nitroprusside or nesiritide may be considered an adjuvant to diuretics for relief of dyspnea in patients admitted with acutely decompensated HF.[46][47] (Level of Evidence: A) " (Level of Evidence: A) "
"7. In patients hospitalized with volume overload, including HF, who have persistent severe hyponatremia and are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT, vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states with either a V2 receptor selective or a nonselective vasopressin antagonist.[48][49] (Level of Evidence: B) "

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References

  1. ↑ 1.0 1.1 1.2 1.3 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  4. ↑ Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD; et al. (2008). "Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial". Circ Heart Fail. 1 (3): 170–7. doi:10.1161/CIRCHEARTFAILURE.108.769778. PMC 2724723. PMID 19675681.
  5. ↑ Chioncel O, Mebazaa A, Maggioni AP, Harjola VP, Rosano G, Laroche C; et al. (2019). "Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry". Eur J Heart Fail. 21 (11): 1338–1352. doi:10.1002/ejhf.1492. PMID 31127678.
  6. ↑ Cleland JG, Chiswell K, Teerlink JR, Stevens S, Fiuzat M, Givertz MM; et al. (2014). "Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study". Circ Heart Fail. 7 (1): 76–87. doi:10.1161/CIRCHEARTFAILURE.113.000284. PMID 24281134.
  7. ↑ Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B; et al. (2013). "Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial". Eur Heart J. 34 (11): 835–43. doi:10.1093/eurheartj/ehs444. PMID 23293303.
  8. ↑ 8.0 8.1 Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J; et al. (2019). "2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee". J Am Coll Cardiol. 74 (15): 1966–2011. doi:10.1016/j.jacc.2019.08.001. PMID 31526538.
  9. ↑ Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF; et al. (2016). "Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction". JACC Heart Fail. 4 (6): 464–72. doi:10.1016/j.jchf.2016.02.017. PMID 27256749.
  10. ↑ Januzzi JL, Sakhuja R, O'donoghue M, Baggish AL, Anwaruddin S, Chae CU; et al. (2006). "Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department". Arch Intern Med. 166 (3): 315–20. doi:10.1001/archinte.166.3.315. PMID 16476871.
  11. ↑ Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L; et al. (2001). "Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting". J Am Coll Cardiol. 37 (2): 379–85. PMID 11216950.
  12. ↑ Mueller C, Scholer A, Laule-Kilian K, Martina B, Schindler C, Buser P; et al. (2004). "Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea". N Engl J Med. 350 (7): 647–54. doi:10.1056/NEJMoa031681. PMID 14960741. Review in: ACP J Club. 2004 Sep-Oct;141(2):35
  13. ↑ van Kimmenade RR, Pinto YM, Bayes-Genis A, Lainchbury JG, Richards AM, Januzzi JL (2006). "Usefulness of intermediate amino-terminal pro-brain natriuretic peptide concentrations for diagnosis and prognosis of acute heart failure". Am J Cardiol. 98 (3): 386–90. doi:10.1016/j.amjcard.2006.02.043. PMID 16860029.
  14. ↑ Bettencourt P, Azevedo A, Pimenta J, Friões F, Ferreira S, Ferreira A (2004). "N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients". Circulation. 110 (15): 2168–74. doi:10.1161/01.CIR.0000144310.04433.BE. PMID 15451800.
  15. ↑ Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A; et al. (2012). "Prediction of heart failure mortality in emergent care: a cohort study". Ann Intern Med. 156 (11): 767–75, W-261, W-262. doi:10.7326/0003-4819-156-11-201206050-00003. PMID 22665814.
  16. ↑ Mebazaa A, Gheorghiade M, Piña IL, Harjola VP, Hollenberg SM, Follath F, Rhodes A, Plaisance P, Roland E, Nieminen M, Komajda M, Parkhomenko A, Masip J, Zannad F, Filippatos G (2008). "Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes". Critical Care Medicine. 36 (1 Suppl): S129–39. doi:10.1097/01.CCM.0000296274.51933.4C. PMID 18158472. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  17. ↑ Costanzo MR, Johannes RS, Pine M, Gupta V, Saltzberg M, Hay J, Yancy CW, Fonarow GC (2007). "The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database". American Heart Journal. 154 (2): 267–77. doi:10.1016/j.ahj.2007.04.033. PMID 17643575. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  18. ↑ Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS (2007). "Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes". Annals of Emergency Medicine. 49 (5): 627–69. doi:10.1016/j.annemergmed.2006.10.024. PMID 17408803. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 19.2 Metra M, Torp-Pedersen C, Cleland JG, Di Lenarda A, Komajda M, Remme WJ, Dei Cas L, Spark P, Swedberg K, Poole-Wilson PA (2007). "Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET". European Journal of Heart Failure. 9 (9): 901–9. doi:10.1016/j.ejheart.2007.05.011. PMID 17581778. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  20. ↑ 20.0 20.1 20.2 Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Sun JL, Yancy CW, Young JB (2008). "Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program". Journal of the American College of Cardiology. 52 (3): 190–9. doi:10.1016/j.jacc.2008.03.048. PMID 18617067. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  21. ↑ 21.0 21.1 Butler J, Young JB, Abraham WT, Bourge RC, Adams KF, Clare R; et al. (2006). "Beta-blocker use and outcomes among hospitalized heart failure patients". J Am Coll Cardiol. 47 (12): 2462–9. doi:10.1016/j.jacc.2006.03.030. PMID 16781374.
  22. ↑ O'Connor CM, Abraham WT, Albert NM, Clare R, Gattis Stough W, Gheorghiade M; et al. (2008). "Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)". Am Heart J. 156 (4): 662–73. doi:10.1016/j.ahj.2008.04.030. PMID 18926148.
  23. ↑ 23.0 23.1 Lappé JM, Muhlestein JB, Lappé DL, Badger RS, Bair TL, Brockman R; et al. (2004). "Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program". Ann Intern Med. 141 (6): 446–53. PMID 15381518.
  24. ↑ Gislason GH, Rasmussen JN, Abildstrom SZ, Schramm TK, Hansen ML, Buch P; et al. (2007). "Persistent use of evidence-based pharmacotherapy in heart failure is associated with improved outcomes". Circulation. 116 (7): 737–44. doi:10.1161/CIRCULATIONAHA.106.669101. PMID 17646585.
  25. ↑ Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R; et al. (2003). "Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure". J Am Coll Cardiol. 42 (7): 1226–33. PMID 14522486.
  26. ↑ 26.0 26.1 McAlister FA, Stewart S, Ferrua S, McMurray JJ (2004). "Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials". Journal of the American College of Cardiology. 44 (4): 810–9. doi:10.1016/j.jacc.2004.05.055. PMID 15312864. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  27. ↑ Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M (1994). "Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial". Annals of Internal Medicine. 120 (12): 999–1006. PMID 8185149. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  28. ↑ Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS (2004). "Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial". Journal of the American Geriatrics Society. 52 (5): 675–84. doi:10.1111/j.1532-5415.2004.52202.x. PMID 15086645. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  29. ↑ 29.0 29.1 Windham BG, Bennett RG, Gottlieb S (2003). "Care management interventions for older patients with congestive heart failure". The American Journal of Managed Care. 9 (6): 447–59, quiz 460–1. PMID 12816174. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  30. ↑ Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR (2004). "Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis". JAMA : the Journal of the American Medical Association. 291 (11): 1358–67. doi:10.1001/jama.291.11.1358. PMID 15026403. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  31. ↑ Koelling TM, Johnson ML, Cody RJ, Aaronson KD (2005). "Discharge education improves clinical outcomes in patients with chronic heart failure". Circulation. 111 (2): 179–85. doi:10.1161/01.CIR.0000151811.53450.B8. PMID 15642765. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  32. ↑ Alikhan R, Cohen AT, Combe S, Samama MM, Desjardins L, Eldor A; et al. (2003). "Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study". Blood Coagul Fibrinolysis. 14 (4): 341–6. PMID 12945875.
  33. ↑ Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel (2012). "Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): 7S–47S. doi:10.1378/chest.1412S3. PMC 3278060. PMID 22315257.
  34. ↑ {{cite journal| author=Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH et al.| title=Association between performance measures and clinical outcomes for patients hospitalized with heart failure. | journal=JAMA | year= 2007 | volume= 297 | issue= 1 | pages= 61-70 | pmid=17200476 | doi=10.1001/jama.297.1.61 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17200476
  35. ↑ Cuffe MS, Califf RM, Adams KF, Benza R, Bourge R, Colucci WS, Massie BM, O'Connor CM, Pina I, Quigg R, Silver MA, Gheorghiade M (2002). "Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial". JAMA : the Journal of the American Medical Association. 287 (12): 1541–7. PMID 11911756. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  36. ↑ Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW (2005). "Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial". JAMA : the Journal of the American Medical Association. 294 (13): 1625–33. doi:10.1001/jama.294.13.1625. PMID 16204662. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  37. ↑ 37.0 37.1 Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, Jaski BE, Fang JC, Feller ED, Haas GJ, Anderson AS, Schollmeyer MP, Sobotka PA (2007). "Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure". Journal of the American College of Cardiology. 49 (6): 675–83. doi:10.1016/j.jacc.2006.07.073. PMID 17291932. Retrieved 2012-04-06. Unknown parameter |month= ignored (help)
  38. ↑ Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR; et al. (2011). "Diuretic strategies in patients with acute decompensated heart failure". N Engl J Med. 364 (9): 797–805. doi:10.1056/NEJMoa1005419. PMC 3412356. PMID 21366472. Review in: Ann Intern Med. 2011 Jul 19;155(2):JC1-5
  39. ↑ Grosskopf I, Rabinovitz M, Rosenfeld JB (1986). "Combination of furosemide and metolazone in the treatment of severe congestive heart failure". Isr J Med Sci. 22 (11): 787–90. PMID 3793436.
  40. ↑ Rosenberg J, Gustafsson F, Galatius S, Hildebrandt PR (2005). "Combination therapy with metolazone and loop diuretics in outpatients with refractory heart failure: an observational study and review of the literature". Cardiovasc Drugs Ther. 19 (4): 301–6. doi:10.1007/s10557-005-3350-2. PMID 16189620.
  41. ↑ Krumholz HM, Chen YT, Wang Y, Vaccarino V, Radford MJ, Horwitz RI (2000). "Predictors of readmission among elderly survivors of admission with heart failure". Am Heart J. 139 (1 Pt 1): 72–7. PMID 10618565.
  42. ↑ Hernandez AF, Greiner MA, Fonarow GC, Hammill BG, Heidenreich PA, Yancy CW; et al. (2010). "Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure". JAMA. 303 (17): 1716–22. doi:10.1001/jama.2010.533. PMID 20442387.
  43. ↑ Kociol RD, Horton JR, Fonarow GC, Reyes EM, Shaw LK, O'Connor CM; et al. (2011). "Admission, discharge, or change in B-type natriuretic peptide and long-term outcomes: data from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) linked to Medicare claims". Circ Heart Fail. 4 (5): 628–36. doi:10.1161/CIRCHEARTFAILURE.111.962290. PMC 3465672. PMID 21743005.
  44. ↑ Giamouzis G, Butler J, Starling RC, Karayannis G, Nastas J, Parisis C; et al. (2010). "Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial". J Card Fail. 16 (12): 922–30. doi:10.1016/j.cardfail.2010.07.246. PMID 21111980.
  45. ↑ Elkayam U, Ng TM, Hatamizadeh P, Janmohamed M, Mehra A (2008). "Renal Vasodilatory Action of Dopamine in Patients With Heart Failure: Magnitude of Effect and Site of Action". Circulation. 117 (2): 200–205. doi:10.1161/CIRCULATIONAHA.107.737106. PMID 18172028.
  46. ↑ Colucci WS, Elkayam U, Horton DP, Abraham WT, Bourge RC, Johnson AD; et al. (2000). "Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group". N Engl J Med. 343 (4): 246–53. doi:10.1056/NEJM200007273430403. PMID 10911006.
  47. ↑ Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF) (2002). "Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial". JAMA. 287 (12): 1531–40. PMID 11911755.
  48. ↑ Ghali JK, Koren MJ, Taylor JR, Brooks-Asplund E, Fan K, Long WA; et al. (2006). "Efficacy and safety of oral conivaptan: a V1A/V2 vasopressin receptor antagonist, assessed in a randomized, placebo-controlled trial in patients with euvolemic or hypervolemic hyponatremia". J Clin Endocrinol Metab. 91 (6): 2145–52. doi:10.1210/jc.2005-2287. PMID 16522696.
  49. ↑ Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS; et al. (2006). "Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia". N Engl J Med. 355 (20): 2099–112. doi:10.1056/NEJMoa065181. PMID 17105757.
  50. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112 (12):e154-235. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202

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