Acute Decompensated Heart Failure

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About Acute Decompensated Heart Failure

Acute decompensated heart failure (ADHF) is a life-threatening condition and is complicated to treat. The most important factors taken into consideration in initial treatment are geared towards congestion reduction and hemodynamic improvement for the patient.

According to U.S. Pharmacist, in three years’ time, more than 107,000 patients enrolled with the Acute Decompensated Heart Failure National Registry (ADHERE). The statistics gathered on these patients indicate a mean age of 72.4, with 52 percent of all enrollees being female. It should be noted that the majority of enrollees also had hypertension (high blood pressure). Another fact of note is that since the time period of the study, the number of enrollees has increased, indicating ADHF could be considered to be a growing health problem.

Causes and Risk Factors

ADHF most often occurs in patients with some form of heart failure, particularly those with some form of structural heart disease or in those who have had or currently do have heart failure symptoms.

As mentioned above, a three year study of enrollees in ADHERE indicated a correlation between patient age and gender, with the occurrence of ADHF. The presence of hypertension was found in a majority of enrollees, possibly indicating a connection between the two.

Signs and Symptoms

The signs of ADHF that may be present in patients include unexplained weight gain, edema (swelling caused by fluid build-up), tachycardia (rapid heart beat), dyspnea on exertion (difficulty in breathing) and positive jugular distention rates.

Other symptoms that may appear in patients with ADHF include ventricular filling murmur, orthopnea (can breath easily only when standing or sitting) and paroxysmal nocturnal dyspnea.


Though there is no ‘formal’ means of diagnosing ADHF, there are signs and symptoms that can indicate its presence to the treating physician.

According to Medscape, the signs of ADHF physicians can use for diagnosis include things that can be measured by a treating physician. These symptoms include:

  • Pitting edema (of greater than 2mm)
  • Rales (present during a pulmonary exam)
  • Elevated right atrial pressure (of less than 10mm Hg)
  • Body weight increase (the amount is dependent upon the patient’s height)

A patient who is at risk for ADHF who has any of these symptoms should immediately contact his or her treating physician about them.

Treatment Options

The use of drug therapy is one treatment that can be used to treat acute decompensated heart failure. When drugs are used for treatment, the patient must be monitored closely due to possible side effects that may make the situation worse.


Acute Decompensated Heart Failure. Medscape/WebMD. Brian F. McBride, PharmD; C. Michael White, PharmD.

Pharmacist’s Role in Acute Decompensated Heart Failure. U.S. Pharmacist. Jerah D. Nordeen, PharmD; Andrew J. Smith, PharmD, BCPS. February 19, 2010.