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Acutely decompensated versus acute heart failure: two different entities

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Abstract

Heart failure (HF) has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention. However, ADCHF and de novo AHF have fundamental pathophysiological differences. Most importantly, the typical illness trajectory of HF, which is similar to that of other chronic organ diseases including lung, renal, and liver failure, features a gradual decline, with acute episodes usually related to disease evolution followed by partial recovery. Thus, ADCHF should be considered part of the natural history of CHF and renamed CHF exacerbation (CHFE) in accordance with the appropriate terminology used in chronic obstructive pulmonary disease. AHF, in turn, should include only acute de novo HF. The clinical implications of this paradigm shift will be in CHFE the change in focus from in-hospital to optimal ambulatory CHF management aiming at primary and secondary CHFE prevention, while in AHF, the institution of measures for in-hospital limitation of cardiac injury and prevention or retardation of symptomatic CHF development.

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Authors and Affiliations

  1. Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece

    Andrew Xanthopoulos, John Skoularigis & Filippos Triposkiadis

  2. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    Javed Butler

  3. Heart Failure Unit, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece

    John Parissis

  4. Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Eftihia Polyzogopoulou

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A.X. has no disclosures

J.B. has received research support from the National Institutes of Health, Patient Centered Outcomes Research Institute and the European Union. He serves as a consultant for Amgen, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceutical, Innolife, Janssen, LinaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, Sanofi, StealthPeptide, V-Wave Limited, Vifor, and ZS Pharma.

J.P. has received horonaria for lectures and advisory boards by Orion Pharma, Novartis, Servier, Pfizer and Roche Diagnostics

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F.T. has received research support and honoraria from Amgen, Bayer, Boehringer Ingelheim, Elpen, Lilly, Menarini, Merck, Novartis, Sanofi, Servier, Vianex and WinMedica.

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Xanthopoulos, A., Butler, J., Parissis, J. et al. Acutely decompensated versus acute heart failure: two different entities. Heart Fail Rev 25, 907–916 (2020). https://doi.org/10.1007/s10741-019-09894-y

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