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The article highlights acute decompensated heart failure (ADHF) without weight gain. Volume overload, low cardiac output and combined fluid overload and shock are the three profiles cited by the American College of Cardiology/American Heart Association for possible ADHF patients. The author says possible detection method for ADHF is combined pressure monitoring and regional volume measurements while treatment options should focus on treating shifts between intravascular volume compartments.

The number of hospitalizations for heart failure has continued to increase despite rapid and significant advances in cardiovascular care. The mortality rate is lower, but morbidity remains significant. In 2004, over 1 million people were hospitalized for heart failure. Conservative estimates indicate that the United States spends more than $33 billion annually, with hospital and nursing home costs consuming 75% of the total, home health care 10%, care providers 8%, and drugs and medical durables 8%. Angiotensin-converting enzyme inhibitor use confers a 16-20% reduction in mortality. β-Blocker use also confers a significant reduction in mortality, as well as reduces hospitalizations. Angiotensin II receptor blockers also reduce mortality and morbidity. Appropriate use of drugs can reduce other costs associated with heart failure. During the past 20 years, many trials in patients with heart failure have been conducted. Those that have demonstrated reductions in morbidity and mortality were reviewed in order to identify the important implications for sound clinical care of patients with heart failure. Managed care practitioners and pharmacists who take the time to revisit pertinent studies will understand how each incremental knowledge enhancement builds on previous data. They will also know which agents are preferred based on well-conducted clinical trials, as well as the target doses at which these agents should be used. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to compare the prognostic efficacy of the 6-min walk (6MW) and cardiopulmonary exercise (CPX) tests in stable outpatients with chronic heart failure (HF)., Background: CPX and 6MW tests are commonly applied as prognostic gauges for systolic HF patients, but few direct comparisons have been conducted., Methods: Stable New York Heart Association (NYHA) functional class II and III systolic HF patients (ejection fraction ≤ 35%) from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were studied. 6MW distance (6MWD) and CPX indices (peak oxygen consumption [VO(2)] and ventilatory equivalents for exhaled carbon dioxide [VE/VCO(2)] slope) were compared as predictors of all-cause mortality/hospitalization and all-cause mortality over 2.5 years of mean follow-up., Results: A total of 2,054 HF-ACTION participants underwent both CPX and 6MW tests at baseline (median age 59 years; 71% male; 64% NYHA functional class II and 36% NYHA functional class III/IV). In unadjusted models and in models that included key clinical and demographic covariates, C-indices of 6MWD were 0.58 and 0.65 (unadjusted) and 0.62 and 0.72 (adjusted) in predicting all-cause mortality/hospitalization and all-cause mortality, respectively. C-indices for peak VO(2) were 0.61 and 0.68 (unadjusted) and 0.63 and 0.73 (adjusted). C-indices for VE/VCO(2) slope were 0.56 and 0.65 (unadjusted) and 0.61 and 0.71 (adjusted); combining peak VO(2) and VE/VCO(2) slope did not improve the C-indices. Overlapping 95% confidence intervals and modest integrated discrimination improvement values confirmed similar prognostic discrimination by 6MWD and CPX indices within adjusted models., Conclusions: In systolic HF outpatients, 6MWD and CPX indices demonstrated similar utility as univariate predictors for all-cause hospitalization/mortality and all-cause mortality. However, 6MWD or CPX indices added only modest prognostic discrimination to models that included important demographic and clinical covariates., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Outpatient care accounts for a significant proportion of total heart failure (HF) expenditures. This observation, plus an expanding list of treatment options, has led to the development of the disease-specific HF clinic., Methods and Results: The goals of the HF clinic are to reduce mortality and rehospitalization rates and improve quality of life for patients with HF through individualized patient care. A variety of staffing configurations can serve to meet these goals. Successful HF clinics require an ongoing commitment of resources, the application of established clinical practice guidelines, an appropriate infrastructure, and a culture of quality assessment., Conclusions: This consensus statement will identify the components of HF clinics, focusing on systems and procedures most likely to contribute to the consistent application of guidelines and, consequently, optimal patient care. The domains addressed are: disease management, functional assessment, quality of life assessment, medical therapy and drug evaluation, device evaluation, nutritional assessment, follow-up, advance planning, communication, provider education, and quality assessment.