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Clinical management of patients with acute heart failure*

Published online by Cambridge University Press:  17 September 2015

Joseph W. Rossano
Joseph W. Rossano*
Affiliation:
Cardiac Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: J. W. Rossano, MD, Cardiac Center, The Children’s Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States of America. Tel: +267 426 3063; E-mail: rossanoj@email.chop.edu
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Abstract

Acute heart failure is a common and serious complication of congenital and acquired heart disease, and it is associated with significant morbidity, mortality, and costs. When a patient is admitted to the hospital with acute heart failure, there are several important goals for the hospital admission, including maintaining adequate perfusion, establishing the underlying aetiology for the heart failure, patient and family education, and discharge from the hospital in a stable condition. The pathway to home discharge is variable and may include inotropic therapy, mechanical circulatory support, and/or heart transplantation. This review will cover the epidemiology, presentation, and management of acute heart failure in children.

Keywords

Acute heart failurepaediatric heart failureventricular assist device

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Footnotes

*

Presented at Johns Hopkins All Children’s Heart Institute, International Pediatric Heart Failure Summit, Saint Petersburg, Florida, United States of America, 4–5 February, 2015.

References

1. Cook, C, Cole, G, Asaria, P, et al. The annual global economic burden of heart failure. Int J Cardiol 2014; 171: 368–376.Google Scholar
2. Go, AS, Mozaffarian, D, Roger, VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation 2014; 129: e28–e292.Google Scholar
3. Mozaffarian, D, Benjamin, EJ, Go, AS, et al. Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation 2015; 131: e29–e322.Google Scholar
4. Ambrosy, AP, Fonarow, GC, Butler, J, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63: 1123–1133.Google Scholar
5. Heidenreich, PA, Albert, NM, Allen, LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013; 6: 606–619.Google Scholar
6. Adams, KF Jr, Fonarow, GC, Emerman, CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149: 209–216.Google Scholar
7. Macicek, SM, Macias, CG, Jefferies, JL, et al. Acute heart failure syndromes in the pediatric emergency department. Pediatrics 2009; 124: e898–e904.Google Scholar
8. Butler, J, Forman, DE, Abraham, WT, et al. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 2004; 147: 331–338.Google Scholar
9. McMurray, JJ, Adamopoulos, S, Anker, SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787–1847.Google Scholar
10. Rossano, JW, Kim, JJ, Decker, JA, et al. Prevalence, morbidity, and mortality of heart failure-related hospitalizations in children in the United States: a population-based study. J Card Fail 2012; 18: 459–470.Google Scholar
11. Watson, RS, Carcillo, JA, Linde-Zwirble, WT, et al. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 167: 695–701.Google Scholar
12. Andrews, RE, Fenton, MJ, Ridout, DA, et al. New-onset heart failure due to heart muscle disease in childhood: a prospective study in the United Kingdom and Ireland. Circulation 2008; 117: 79–84.Google Scholar
13. Wittlieb-Weber, CA, Lin, KY, Zaoutis, TE, et al. Pediatric versus adult cardiomyopathy and heart failure-related hospitalizations: a value-based analysis. J Card Fail 2015; 21: 76–82.Google Scholar
14. Grady, KL, Dracup, K, Kennedy, G, et al. Team management of patients with heart failure: a statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association. Circulation 2000; 102: 2443–2456.Google Scholar
15. Nohria, A, Tsang, SW, Fang, JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 2003; 41: 1797–1804.Google Scholar
16 Publication Committee for the Vmac Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA 2002; 287: 1531–1540.Google Scholar
17. McMurray, JJ, Adamopoulos, S, Anker, SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 803–869.Google Scholar
18. O’Connor, CM, Starling, RC, Hernandez, AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 2011; 365: 32–43.Google Scholar
19. Felker, GM, Lee, KL, Bull, DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011; 364: 797–805.Google Scholar
20. Mentz, RJ, Stevens, SR, DeVore, AD, et al. Decongestion strategies and renin-angiotensin-aldosterone system activation in acute heart failure. JACC Heart Fail 2015; 3: 97–107.Google Scholar
21. Price, JF, Mott, AR, Dickerson, HA, et al. Worsening renal function in children hospitalized with decompensated heart failure: evidence for a pediatric cardiorenal syndrome? Pediatr Crit Care Med 2008; 9: 279–284.Google Scholar
22. Dupont, M, Wu, Y, Hazen, SL, et al. Cystatin C identifies patients with stable chronic heart failure at increased risk for adverse cardiovascular events. Circ Heart Fail 2012; 5: 602–609.Google Scholar
23. Pronschinske, KB, Qiu, S, Wu, C, et al. Neutrophil gelatinase-associated lipocalin and cystatin C for the prediction of clinical events in patients with advanced heart failure and after ventricular assist device placement. J Heart Lung Transplant 2014; 33: 1215–1222.Google Scholar
24. Damman, K, Valente, MA, Voors, AA, et al. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J 2014; 35: 455–469.Google Scholar
25. Shlipak, MG, Massie, BM. The clinical challenge of cardiorenal syndrome. Circulation 2004; 110: 1514–1517.Google Scholar
26. Klein, L, Massie, BM, Leimberger, JD, et al. Admission or changes in renal function during hospitalization for worsening heart failure predict postdischarge survival: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF). Circ Heart Fail 2008; 1: 25–33.CrossRefGoogle ScholarPubMed
27. Packer, M, Carver, JR, Rodeheffer, RJ, et al. Effect of oral milrinone on mortality in severe chronic heart failure. N Engl J Med 1991; 325: 1468–1475.Google Scholar
28. Cuffe, MS, Califf, RM, Adams, KF Jr, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 2002; 287: 1541–1547.Google Scholar
29. Costanzo, MR, Johannes, RS, Pine, M, et al. The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database. Am Heart J 2007; 154: 267–277.Google Scholar
30. Abraham, WT, Adams, KF, Fonarow, GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol 2005; 46: 57–64.Google Scholar
31. Felker, GM, Benza, RL, Chandler, AB, et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol 2003; 41: 997–1003.Google Scholar
32. Shamszad, P, Hall, M, Rossano, JW, et al. Characteristics and outcomes of heart failure-related intensive care unit admissions in children with cardiomyopathy. J Card Fail 2013; 19: 672–677.Google Scholar
33. Price, JF, Towbin, JA, Dreyer, WJ, et al. Outpatient continuous parenteral inotropic therapy as bridge to transplantation in children with advanced heart failure. J Card Fail 2006; 12: 139–143.Google Scholar
34. Towbin, JA, Lowe, AM, Colan, SD, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 2006; 296: 1867–1876.Google Scholar
35. Azakie, A, Russell, JL, McCrindle, BW, et al. Anatomic repair of anomalous left coronary artery from the pulmonary artery by aortic reimplantation: early survival, patterns of ventricular recovery and late outcome. Ann Thorac Surg 2003; 75: 1535–1541.Google Scholar
36. Fesseha, AK, Eidem, BW, Dibardino, DJ, et al. Neonates with aortic coarctation and cardiogenic shock: presentation and outcomes. Ann Thorac Surg 2005; 79: 1650–1655.Google Scholar
37. Jefferies, JL, Towbin, JA. Dilated cardiomyopathy. Lancet 2010; 375: 752–762.Google Scholar
38. Friedrich, MG, Sechtem, U, Schulz-Menger, J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol 2009; 53: 1475–1487.Google Scholar
39. Nugent, AW, Davis, AM, Kleinert, S, et al. Clinical, electrocardiographic, and histologic correlations in children with dilated cardiomyopathy. J Heart Lung Transplant 2001; 20: 1152–1157.Google Scholar
40. Bowles, NE, Ni, J, Kearney, DL, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. Evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003; 42: 466–472.Google Scholar
41. Neilan, TG, Coelho-Filho, OR, Danik, SB, et al. CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy. JACC Cardiovasc Imaging 2013; 6: 944–954.Google Scholar
42. Gulati, A, Jabbour, A, Ismail, TF, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA 2013; 309: 896–908.Google Scholar
43. Puntmann, VO, Voigt, T, Chen, Z, et al. Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. JACC Cardiovasc Imaging 2013; 6: 475–484.Google Scholar
44. Yamada, T, Hirashiki, A, Cheng, XW, et al. Relationship of myocardial fibrosis to left ventricular and mitochondrial function in nonischemic dilated cardiomyopathy—a comparison of focal and interstitial fibrosis. J Card Fail 2013; 19: 557–564.Google Scholar
45. Bennett, MK, Gilotra, NA, Harrington, C, et al. Evaluation of the role of endomyocardial biopsy in 851 patients with unexplained heart failure from 2000-2009. Circ Heart Fail 2013; 6: 676–684.Google Scholar
46. Daly, KP, Marshall, AC, Vincent, JA, et al. Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: results of a multicenter experience. J Heart Lung Transplant 2012; 31: 398–409.Google Scholar
47. Yoshizato, T, Edwards, WD, Alboliras, ET, et al. Safety and utility of endomyocardial biopsy in infants, children and adolescents: a review of 66 procedures in 53 patients. J Am Coll Cardiol 1990; 15: 436–442.Google Scholar
48. Zhorne, D, Petit, CJ, Ing, FF, et al. A 25-year experience of endomyocardial biopsy safety in infants. Catheter Cardiovasc Interv 2013; 82: 797–801.Google Scholar
49. O’Connor, MJ, Rossano, JW. Ventricular assist devices in children. Curr Opin Cardiol 2014; 29: 113–121.Google Scholar
50. Wilmot, I, Morales, DL, Price, JF, et al. Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. J Card Fail 2011; 17: 487–494.Google Scholar
51. Mossad, EB, Motta, P, Rossano, J, et al. Perioperative management of pediatric patients on mechanical cardiac support. Paediatr Anaesth 2011; 21: 585–593.Google Scholar
52. Cabrera, AG, Sundareswaran, KS, Samayoa, AX, et al. Outcomes of pediatric patients supported by the HeartMate II left ventricular assist device in the United States. J Heart Lung Transplant 2013; 32: 1107–1113.Google Scholar
53. Morales, DL, Braud, BE, Price, JF, et al. Use of mechanical circulatory support in pediatric patients with acute cardiac graft rejection. ASAIO J 2007; 53: 701–705.Google Scholar
54. Teele, SA, Allan, CK, Laussen, PC, et al. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011; 158: 638–643.Google Scholar
55. Fraser, CD Jr, Jaquiss, RD, Rosenthal, DN, et al. Prospective trial of a pediatric ventricular assist device. N Engl J Med 2012; 367: 532–541.Google Scholar
56. Singh, TP, Almond, CS, Semigran, MJ, et al. Risk prediction for early in-hospital mortality following heart transplantation in the United States. Circ Heart Fail 2012; 5: 259–266.Google Scholar
57. Dipchand, AI, Kirk, R, Edwards, LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Heart Transplantation Report–2013; focus theme: age. J Heart Lung Transplant 2013; 32: 979–988.Google Scholar
58. Almond, CS, Morales, DL, Blackstone, EH, et al. Berlin Heart EXCOR pediatric ventricular assist device for bridge to heart transplantation in US children. Circulation 2013; 127: 1702–1711.Google Scholar
59. Morales, DL, Almond, CS, Jaquiss, RD, et al. Bridging children of all sizes to cardiac transplantation: the initial multicenter North American experience with the Berlin Heart EXCOR ventricular assist device. J Heart Lung Transplant 2011; 30: 1–8.Google Scholar
60. Rossano, JW, Woods, RK, Berger, S, et al. Mechanical support as failure intervention in patients with cavopulmonary shunts (MFICS): rationale and aims of a new registry of mechanical circulatory support in single ventricle patients. Congenit Heart Dis 2013; 8: 182–186.Google Scholar
61. Rossano, JW, Goldberg, DJ, Fuller, S, et al. Successful use of the total artificial heart in the failing Fontan circulation. Ann Thorac Surg 2014; 97: 1438–1440.Google Scholar
62. Conway, J St. Louis, J, Morales, DL, et al. Delineating survival outcomes in children <10 kg bridged to transplant or recovery with the Berlin Heart EXCOR Ventricular Assist Device. JACC Heart Fail 2015; 3: 70–77.Google Scholar
63. Weinstein, S, Bello, R, Pizarro, C, et al. The use of the Berlin Heart EXCOR in patients with functional single ventricle. J Thorac Cardiovasc Surg 2014; 147: 697–704.Google Scholar
64. Lowry, AW, Adachi, I, Gregoric, ID, et al. The potential to avoid heart transplantation in children: outpatient bridge to recovery with an intracorporeal continuous-flow left ventricular assist device in a 14-year-old. Congenit Heart Dis 2012; 7: E91–E96.Google Scholar
65. Irving, CA, Crossland, DS, Haynes, S, et al. Evolving experience with explantation from Berlin Heart EXCOR ventricular assist device support in children. J Heart Lung Transplant 2014; 33: 211–213.Google Scholar
66. Kirklin, JK, Naftel, DC, Pagani, FD, et al. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant 2014; 33: 555–564.Google Scholar
67. Amodeo, A, Adorisio, R. Left ventricular assist device in Duchenne cardiomyopathy: can we change the natural history of cardiac disease? Int J Cardiol 2012; 161: e43.Google Scholar
68. Birnbaum, BF, Simpson, KE, Boschert, TA, et al. Intravenous home inotropic use is safe in pediatric patients awaiting transplantation. Circ Heart Fail 2015; 8: 64–70.Google Scholar
69. Everitt, MD, Sleeper, LA, Lu, M, et al. Recovery of echocardiographic function in children with idiopathic dilated cardiomyopathy: results from the pediatric cardiomyopathy registry. J Am Coll Cardiol 2014; 63: 1405–1413.CrossRefGoogle ScholarPubMed
70. Alexander, PM, Daubeney, PE, Nugent, AW, et al. Long-term outcomes of dilated cardiomyopathy diagnosed during childhood: results from a national population-based study of childhood cardiomyopathy. Circulation 2013; 128: 2039–2046.Google Scholar
71. O’Sullivan, JJ, Roche, SL, Crossland, DS, et al. Recovery of heart function in children with acute severe heart failure. Transplantation 2008; 85: 975–979.Google Scholar