Acute heart failure – an EFIM guideline critical appraisal and adaptation for internists

Valentin A. Kokorin, Alvaro González-Franco, Antonio Cittadini, Oskars Kalējs, Vera N. Larina, Alberto M. Marra, Francisco J. Medrano (Corresponding Author), Zdenek Monhart, Laura Morbidoni, Joana Pimenta, Wiktoria Lesniak

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: Over the past two decades, several studies have been conducted that have tried to answer questions on management of patients with acute heart failure (AHF) in terms of diagnosis and treatment. Updated international clinical practice guidelines (CPGs) have endorsed the findings of these studies. The aim of this document was to adapt recommendations of existing guidelines to help internists make decisions about specific and complex scenarios related to AHF. Methods: The adaptation procedure was to identify firstly unresolved clinical problems in patients with AHF in accordance with the PICO (Population, Intervention, Comparison and Outcomes) process, then conduct a critical assessment of existing CPGs and choose recommendations that are most applicable to these specific scenarios. Results: Seven PICOs were identified and CPGs were assessed. There is no single test that can help clinicians in discriminating patients with acute dyspnoea, congestion or hypoxaemia. Performing of echocardiography and natriuretic peptide evaluation is recommended, and chest X-ray and lung ultrasound may be considered. Treatment strategies to manage arterial hypotension and low cardiac output include short-term continuous intravenous inotropic support, vasopressors, renal replacement therapy, and temporary mechanical circulatory support. The most updated recommendations on how to treat specific patients with AHF and certain comorbidities and for reducing post-discharge rehospitalization and mortality are provided. Overall, 51 recommendations were endorsed and the rationale for the selection is provided in the main text. Conclusion: Through the use of appropriate tailoring process methodology, this document provides a simple and updated guide for internists dealing with AHF patients.

Original languageEnglish
Pages (from-to)4-14
Number of pages11
JournalEuropean Journal of Internal Medicine
Volume123
DOIs
Publication statusPublished - May 2024

Keywords*

  • Acute heart failure
  • Clinical practice guideline
  • Consensus
  • Critical assessment
  • Internal medicine

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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