Heart failure, acute diagnosis

Total estimated direct and indirect costs for managing both chronic and acute HF in the United States for 2005 was approximately 27.9 billion. Medications account for approximately 10% of that cost.3 Heart failure is the most common hospital discharge diagnosis for Medicare patients and is the most costly diagnosis in this population. 

Clinical Presentation and Diagnosis of Acute Heart Failure... 

Suggested Alternatives for Differential Diagnosis Acute respiratory distress syndrome, congestive heart failure, pulmonary edema, AIDS, pneumonia, cardiogenic shock, septic shock, phosgene toxicity, phosphine toxicity, salicylate toxicity with pulmonary edema, influenza, plague, tularemia, and anthrax. 

A preliminary diagnosis of acute heart failure is made. 

Although the heart is an efficient and durable pump, there are a variety of problems that can diminish cardiac function and lead to a variety of abnormal states. One of these problems is heart failure. It and acute ischemic heart disease are the most common diseases that rely on a biochemical diagnosis and thus will be the major focus of this chapter. ... 

The development of a bedside assay for plasma BNP has focused considerable attention on the use of BNP as an aid in the diagnosis of suspected heart failure. Plasma BNP concentration is positively correlated with the degree of left ventricular dysfunction and heart failure, and this assay is now used frequently in acute care settings to assist in the differential diagnosis of dyspnea [heart failure versus asthma, chronic obstructive pulmonary disease (COPD), or infection]. Recent studies found that an elevated BNP concentration is an independent predictor of heart failure as the cause of dyspnea and that in patients with decompensated heart failure, an elevated pre-hospital discharge BNP concentration is associated with an increased risk of death or readmission. Additional research is ongoing to better characterize the role of BNP measurement in the diagnosis and treatment of heart failure. 

Note Added in Proof. The European Society of Cardiology released new treatment guidelines in February 2005 for the diagnosis and treatment of acute heart failure. (Nieminen MS, Bohm M, Cowie MR, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. The Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005 26 384-416.)... 

Cardiovascular Among 82717 US veterans with a new diagnosis of COPD, who were followed until they had their first hospitalization for a cardiovascular event, or died, or reached the end of the study period, there were 6234 cardiovascular events (44% heart failure, 28% acute coronary syndrome, and 28% cardiac dysrhythmias) [27. The risk of cardiovascular events was increased in those who had used ipratropium in the past 6 months (HR=1.40 95% Cl = 1.3, 1.5). Among those who had used an anticholinergic drug more than 6 months before, there did not appear to be an increased risk of a cardiovascular event. This study was limited, owing to incomplete hospital admission data and lack of data on cardiovascular risk factors and severity of COPD. 

Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008 29(19) 2388-442. 

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