Guidelines for Acute Decompensated Heart Failure Treatment

Author:

DiDomenico Robert J1,Park Hayley Y2,Southworth Mary Ross3,Eyrich Heather M4,Lewis Richard K5,Finley Jamie M6,Schumock Glen T7

Affiliation:

1. Robert J DiDomenico PharmD, Clinical Assistant Professor, Department of Pharmacy Practice; Affiliate Faculty, Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL

2. Hayley Y Park PharmD, Research Fellow, Center for Pharmacoeconomic Research

3. Mary Ross Southworth PharmD, Clinical Assistant Professor, Department of Pharmacy Practice and Section of Cardiology, University of Illinois at Chicago

4. Heather M Eyrich PharmD, Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

5. Richard K Lewis PharmD MBA, Vice President, Pharmacy Services, Mercy Resource Management, Inc., Naperville, IL; Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

6. Jamie M Finley PharmD, Coordinator of Clinical Pharmacy Programs, Mercy Resource Management, Inc., Naperville, IL; Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

7. Glen T Schumock PharmD MBA FCCP, Director, Center for Pharmacoeconomic Research, University of Illinois at Chicago; Associate Professor, Department of Pharmacy Practice, University of Illinois at Chicago

Abstract

OBJECTIVE To describe the development of guidelines for the treatment of acute decompensated heart failure (ADHF) in the emergency department/observation unit (ED-OU) setting for hospitals that are part of a group purchasing organization (GPO). DATA SOURCES A MEDLINE search (1966-March 2003) using the following search terms: cardiotonic agents; diuretic; dobutamine; heart failure, congestive; milrinone; natriuretic peptide, brain; nesiritide; nitroglycerin; vasodilator agents, was conducted. STUDY SELECTION AND DATA EXTRACTION Relevant articles in the English language were identified. All randomized studies and meta-analyses for each category of drugs were included. DATA SYNTHESIS A group consensus method was used to develop guidelines. An expert panel reviewed and revised the guidelines. The final guidelines were approved June 1, 2003, and are described here. They are organized based upon a patient's symptomatology at the time the diagnosis of ADHF is made. Patients with evidence of volume overload require intravenous diuretics and/or intravenous vasodilators to alleviate the symptoms of ADHF. Patients with signs and symptoms of low cardiac output require inotropic support to manage their ADHF. A timeline for diagnosis, treatment, reassessment, and disposition is provided and encourages an early, aggressive approach to treating patients with ADHF. CONCLUSIONS Hospitalization for ADHF is common and costly. Consensus guidelines for the treatment of ADHF did not previously exist, resulting in inconsistent and inefficient treatment. Consequently, hospitals struggling with the treatment of ADHF may find these guidelines and the process by which they were developed useful. THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-015-H01

Publisher

SAGE Publications

Subject

Pharmacology (medical)

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