急性失代偿心衰液体过负荷的处理（英文）.pdf

Overall Approach to Fluid Overload in Acutely Decompensated Heart Failure William T. Abraham, MD, FACP, FACC Professor of Medicine, Physiology, and Cell Biology Chief, Division of Cardiovascular Medicine Deputy Director, Davis Heart Lung Research Institute The Ohio State University Columbus, Ohio Disclosures: Nothing to disclose. Standard of Care in ADHF • In the U.S., no evidence-based guidelines exist for the management of ADHF • The effects of “traditional” or “standard” therapies – including IV diuretics, nitrates, dobutamine, and milrinone – on outcomes have not been evaluated • These agents may be referred to as standard therapies simply because they came along before more contemporary treatments Clinical Trials in ADHF • Very few large-scale randomized controlled trials have prospectively evaluated the effects of ADHF treatments on outcomes and none have definitively demonstrated improved outcomes • Retrospective analyses of smaller trials have raised concern about some agents • The following approach to fluid overload in ADHF is based on consensus among heart failure specialists Heart Failure Hospitalizations are Increasing 600,000 500,000 s 400,000 e g r a 300,000 h c s i D 200,000 Women 100,000 Men 0 9 1 3 5 7 9 1 3 5 7 7 8 8 8 8 8 9 9 9 9 CDC/NCHS: Hospital discharges include patients both living and dead. AHA Heart and