[Pharmacotherapy of acute heart failure: update and perspectives]

Abstract

In acute decompensated heart failure rapid diagnosis and causal therapy are necessary to avoid cardiogenic shock. Treatment goals are to decrease congestion, afterload, and neurohormonal activation in order to improve hemodynamics and symptoms and, perhaps, reduce in-hospital events, re-hospitalizations, and mortality. A combined medical therapy of diuretics and / or vasodilators should be favoured in order to protect organs and to avoid toxicities of therapy such as hypotension, arrhythmias and renal dysfunction. Intravenous inotropes, such as dobutamine and milrinone, should be limited to hypotensive patients with evidence of poor tissue perfusion. They improve hemodynamics and organ perfusion but result in a higher mortality due to to proarrhythmogenic effects. Therefore, they should be given in lowest doses and should be withdrawn as early as possible. A preexisting therapy with betablockers should be continued if there is no hemodynamic instability. Before demission any patient should be on betablockers and ACE inhibitors according to national guidelines resulting in a decrease of re-hospitalization and mortality rates. New medical therapies should at least improve clinical symptoms and favourably reduce re-hospitalization and mortality rates.