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Eur J Heart Fail. 2018 Jul;20(7):1081-1099. doi: 10.1002/ejhf.1204. Epub 2018 Apr 30.

Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

Author information

1
Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
2
Athens University Hospital Attikon, Athens, Greece.
3
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
4
Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania.
5
University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease, Bucharest, Romania.
6
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
7
Department of Intensive Care Medicine, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.
8
Département d'Anesthésie- Réanimation-SMUR, Hôpitaux Universitaires Saint Louis-Lariboisière, INSERM-UMR 942, AP-, HP, Université Paris Diderot, Paris, France.
9
Queens University, Belfast, UK.
10
Department of Internal Medicine and Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia.
11
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
12
Cardiology, Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
13
Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.
14
Hospital Sanitas CIMA, Barcelona, Spain.
15
U942 INSERM, AP-HP, Paris, France.
16
Investigation Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France.
17
University Paris Diderot, Sorbonne Paris Cité, Paris, France.
18
AP-HP, Department of Anesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France.
19
Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.
20
Department of Cardiology, Policlinico di Monza, Monza, Italy.
21
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
22
Department of Cardiology, Ziekenhuis Oost Limburg, Genk - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
23
Department of Cardiology, University of Helsinki, Helsinki, Finland.
24
Cardio-surgical Intensive Care Unit, University and University Hospital Zurich, Zurich, Switzerland.
25
University Heart Center, University Hospital Zurich, Zurich, Switzerland.
26
Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia.
27
Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
28
INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807 Villejuif, France, University Hospital Ambroise Paré, AP-, HP, Boulogne-Billancourt, France.
29
Cardiology Division, Soroka University Medical Centre, Beer-Sheva, Israel.
30
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
31
Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain.
32
Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy.
33
Imperial College, London, UK.

Abstract

This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.

KEYWORDS:

Heart failure; Inpatients; Monitoring, physiologic

PMID:
29710416
DOI:
10.1002/ejhf.1204

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