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CARDIOLOGY

Guidelines for Acute Decompensated Heart Failure Treatment

Clinical Assistant Professor, Department of Pharmacy Practice; Affiliate Faculty, Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL

Hayley Y Park, PharmD

Research Fellow, Center for Pharmacoeconomic Research

Mary Ross Southworth, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice and Section of Cardiology, University of Illinois at Chicago

Heather M Eyrich, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

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

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

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

Reprints: Glen T Schumock PharmD MBA FCCP, Center for Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. (M/C 886), Chicago, IL 60612-7230, fax 312/996-0379, schumock{at}uic.edu

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.

Key Words: emergency department, guidelines, heart failure, observation unit

Published Online, February 24, 2004. www.theannals.com, DOI 10.1345/aph.1D481

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-015-H01

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