Acute Decompensated Heart Failure: A Pharmacotherapy Approach

Five million people in the United States are living with heart failure and this number continues to climb.¹  Patients with this chronic disease commonly present to the hospital in what is known as acute decompensated heart failure (ADHF). The prognosis of ADHF is poor, with in-hospital mortality ranging from 4% to 7%, 60- to 90-day mortality ranging from 7% to 11%, and 60- to 90-day rehospitalization rates ranging from 25% to 30%.² 

A patient experiencing ADHF typically displays shortness of breath (due to low cardiac output), pulmonary edema, or a combination of the two. Patients are classified into 1 of 4 Forrester hemodynamic subsets based on the presenting clinical syndrome (see Figure).³  This classification system helps health care providers develop appropriate treatment plans using medications such as diuretics, vasodilators, and inotropic agents (Table 1).^4–10  Once hemodynamic stabilization is achieved, initiating or...