Acute heart failure (AHF) is a clinical syndrome, which complicates the course of numerous cardiovascular diseases; it appears suddenly or is characterized by rapid or steadily progressing exacerbation of HF symptoms, which require immediate hospitalization and specialized care. In spite of great contribution of health care and financial expenses connected with AHF and chronic heart failure (CHF), a lot of issues still remain unresolved in the field of diagnosis, drug therapy, prognosis and prevention of this syndrome. A high incidence of comorbid pathology is revealed, which to a great extent determines the occurrence, development and prognosis of AHF. Detection of malignant neoplasms in patients with the previously diagnosed HF has become very frequent, and specialists express concern regarding diagnosis of cancer in patients with HF.
Some clinical and laboratory cardiovascular, noncardial, patient-conditioned or iatrogenic indices are independent predictors of the outcome in AH. To assess the risk of unfavorable outcomes in case of hospitalization, it is necessary to develop and implement into practical health care risk scores based on generally accessible indices, which will make it possible to define with a high degree of accuracy the risk of hospital lethality of the patient.
Each hospitalization in case of AHF is connected with deterioration of the heart function, which is never restored to the initial condition after the discharge from the hospital and is accompanied by progressing HF. The average survival of patients with HF decreases in proportion to the number of hospitalizations, therefore, for prevention of AHF episodes it is necessary to fully arrest the congestive conditions in the hospital, to educate patients with CHF, to patiently titrate oral medications to the maximally tolerated effective doses, to thoroughly monitor patients after the discharge from the hospital in order to reveal and correct decompensation as early as possible. It is useful to develop a modern and effective model of monitoring the course of the disease, capable of improving the efficiency of medical care, the quality of life and prognosis of patients – telemedical monitoring.
After the hospitalization of the patient with AHF it is necessary to assess the clinical status for the identification of life-threatening syndromes which require specific organizational tactics: acute coronary syndrome; hemodynamic “catastrophe”, respiratory failure, life-threatening tachi- or bradyarrythmia. Practical health care faces a set of tasks, which call for continuous improvement and assistance of scientists: improvement of the quality of life for patients with HF, decrease in mortality, reduction of the number and duration of rehospitalizations; refinement and creation of new diagnostic and therapeutic technologies, prompt selection of patients, who can be helped by nondrug therapy (invasive ventilation, temporary assist circulation) and in the future – resynchronization therapy or heart transplantation, optimization of drug therapy of CHF and of diseases, which triggered AHF, after the stabilization of the condition and before the discharge from the hospital.2018 Том 2, №1