From Parker RE Rodgers JE Cavallari JH Heart failure In DiPlro JTP Talbert RL Vee GC etsjl eds Pharmacotherapy A Pathophysiologic Approach 7th ed New York McGraw Hill 2000203

Treatment of AHF Desired Therapeutic Outcomes

The goals of therapy for AHF are to: (a) correct the underlying precipitating factor(s); (b) relieve the patient's symptoms; (c) improve hemodynamics; (d) optimize a chronic oral medication regimen; and (e) educate the patient, reinforcing adherence to lifestyle modifications and the drug regimen. The ultimate goal for a patient hospitalized for AHF is the return to a compensated HF state and discharge to the outpatient setting on oral medications. Only through aggressive management to achieve all of these goals will a patient's prognosis be improved and future hospitalizations for acute decompensations prevented.

Removal or control of precipitating factors is essential for an optimal response to pharmacologic therapy. Relief of symptoms should occur rapidly to minimize length of hospitalization. Although a rapid discharge from the hospital is desirable, a patient should not be discharged before ensuring that he or she is in a euvolemic, or nearly euvolemic, state with a body weight and functional capacity similar to before the acute decompensation. Oral agents such as P-blockers, ACE inhibitors or ARBs, and aldosterone antagonists should be initiated as soon as possible during the hos-pitalization. These chronic oral medications not only improve mortality and prevent readmissions, acutely they also contribute to improvement in hemodynamics. Patient education prior to discharge from the hospital is recommended to assist in minimizing adverse effects and nonadherence. Dissemination of written information, in addition to verbal information, is helpful for patient comprehension and retention. This can include therapy goals, lifestyle modifications, drug regimen, dosage information, and relevant adverse effects, as well as symptom and diary cards.

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