Acute decompensated heart failure (ADHF) refers to the new onset or worsening of signs and symptoms of heart failure, often resulting in hospitalization. It is a common and potentially life-threatening presentation in emergency departments and intensive care units. The pharmacist plays a pivotal role in assisting the medical team with prompt recognition, risk stratification, diagnosis, and evidence-based management of ADHF.
- ADHF accounts for over 1 million hospitalizations annually in the United States.
- The incidence of ADHF increases with age, with the highest rates in patients over 85 years old.
- ADHF carries high morbidity and mortality. The 1-year mortality rate approaches 30% in some studies.
Etiology and Pathophysiology
ADHF can occur due to various etiologies:
- Acute myocardial infarction
- Uncontrolled hypertension
- Valvular disorders (e.g. mitral regurgitation)
- Arrhythmias (e.g. atrial fibrillation)
- Medication or dietary noncompliance
- Endocrine disorders (e.g. hyperthyroidism, adrenal insufficiency)