Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine - short version
Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine - short version
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DOI：
10.1093/eurheartj/ehv066
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发表时间：
2015-08-07
影响因子：
39.3
通讯作者：
Filippatos, Gerasimos
中科院分区：
文献类型：
--
作者：
Mebazaa, Alexandre;Yilmaz, M. Birhan;Filippatos, Gerasimos
急性心力衰竭是一种综合征，急诊医生、心脏病专家、重症监护医生、护士和其他医疗保健提供者必须合作，为患者提供“快速”的益处。我们特此强调在急性心力衰竭重症监护领域的不同环境中积累的更广泛的经验，实际上比专业护理病房的经验更大、更综合。本文件对这些不同经验的精华进行了讨论和整合。因此，本共识文件的作者认为，必须对 AHF 制定一个涵盖所有维度和表现方式的通用工作定义，并理解大多数 AHF 表现要么是慢性潜在心力衰竭的急性失代偿，要么是与血压显着升高相关的呼吸困难突然发作。其次，最近的数据表明，就像急性冠状动脉综合征一样，急性心力衰竭可能有一个“治疗时间”的概念。因此，“院前”管理被认为是护理的重要组成部分。第三，大多数 AHF 患者就诊时血压正常或高血压，入院时有充血症状和/或体征。这与低心输出量导致症状性低血压和低灌注体征/症状的说法相矛盾，这种情况相对罕见，存在于冠心病监护病房/重症监护病房（CCU/ICU）中，但与特别不良的结果相关。因此，重要的是要注意适当的治疗需要适当识别特定的 AHF 表型。 3 本文的目的不是取代指南，而是在最新数据的背景下为早期医院管理提供当代视角，并根据专家意见为执业医生和其他医疗保健专业人员提供指导（图 1）。我们相信，从急诊室到 ICU/CCU 的不同环境中积累的经验对于确定如何最好地管理 AHF 患者具有集体价值。这里，提供了主要包括组推荐的缩短版本。共识文件的完整版本作为补充材料在线提供。
Acute heart failure is a syndrome in which emergency physicians, cardiologists, intensivists, nurses, and other healthcare providers have to cooperate to provide ‘rapid’benefit to the patients. We hereby would like to underscore the wider experience grown in different settings of the area of intensive care on acute heart failure, actually larger and more composite than that got in specialized Care Units. The distillateofsuchdifferentexperiencesisdiscussedandintegratedinthe present document. Hence, the authors of this consensus paper believe a common working definition of AHF covering all dimensions and modes of presentations has to be made, with the understanding that most AHF presentations are either acute decompensations of chronic underlying HF or the abrupt onset of dyspnoea associated with significantly elevated blood pressure. Secondly, recent data show that, much like acute coronary syndrome, AHF might have a ‘time to therapy’concept. Accordingly,‘pre-hospital’management is considered a critical component of care. Thirdly, most patients with AHF have normal or high blood pressure at presentation, and are admitted with symptoms and/or signs of congestion. This is in contradiction to the presentation where low cardiac output leads to symptomatic hypotension and signs/symptoms of hypoperfusion, a circumstance that is relatively rare, present in coronary care unit/intensive care unit (CCU/ICU) but associated with a particularly poor outcome. Hence, it is important to note that appropriate therapy requires appropriate identification of the specific AHF phenotype. 3 The aim of the current paper is not to replace guidelines, but, to provide contemporary perspective for early hospital management within the context of the most recent data and to provide guidance, based on expert opinions, to practicing physicians and other healthcare professionals (Figure 1). We believe that the experience accrued in the different settings from the emergency department through to the ICU/CCU is collectivel valuable in determining how best to manage the patients with AHF. Herein, a shortened version mainly including group recommendations is provided. Full version of the consensus paper is provided as Supplementary material online.