Acute decompensated heart failure (ADHF) refers to the new onset or worsening of signs and symptoms of heart failure, often resulting in hospitalization. It is a common and potentially life-threatening presentation in emergency departments and intensive care units. The pharmacist plays a pivotal role in assisting the medical team with prompt recognition, risk stratification, diagnosis, and evidence-based management of ADHF.

Epidemiology

• ADHF accounts for over 1 million hospitalizations annually in the United States.
• The incidence of ADHF increases with age, with the highest rates in patients over 85 years old.
• ADHF carries high morbidity and mortality. The 1-year mortality rate approaches 30% in some studies.

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Etiology and Pathophysiology

ADHF can occur due to various etiologies:

• Acute myocardial infarction
• Uncontrolled hypertension
• Valvular disorders (e.g. mitral regurgitation)
• Arrhythmias (e.g. atrial fibrillation)
• Medication or dietary noncompliance
• Infection
• Endocrine disorders (e.g. hyperthyroidism, adrenal insufficiency)