Acute Heart Failure – ABC CARDIOL

ABCHF

Review Article

Circulatory Support Devices in Acute Heart Failure: Which and When?

Deborah de Sá Pereira Belfort et al. Rafael Cavalcanti Tourinho Dantas Silvia Moreira Ayub-Ferreira

Introduction

Acute heart failure (AHF), which is the syndrome where there is a rapid or gradual worsening of chronic or new heart failure (HF), is one of the main causes of emergency department visits, and it is the leading cause responsible for non-elective hospitalizations in patients over 65 years of age, with an elevated readmission rate at 1 year. In-hospital mortality due to AHF is 3% to 4% in international registries, reaching 12.6% in the Brazilian BREATHE registry. When we analyze the most severe spectrum of AHF, which is cardiogenic shock (CS), in-hospital mortality varies from 32% to 58%, even in international registries.^,

The path to reducing the elevated morbidity and mortality of AHF and CS involves quick and accurate identification and diagnosis, recognition and treatment of decompensating factors, assessment of severity and associated comorbidities, and quick and appropriate implementation of specific therapies to restore multiple organ perfusion.

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Original Article

Safety and Efficacy of Aerobic Exercise Training Associated to Non-Invasive Ventilation in Patients with Acute Heart Failure

Mayron F. Oliveira et al. Rita C. Santos Suellen A. Artz Vanessa M. F. Mendez … Denise M. L. Lobo Edileide B. Correia Almir S. Ferraz Iracema I. K. Umeda Priscila A. Sperandio

Abstract

Background:

Exercise training (ET) improves functional capacity in chronic heart failure (HF). However, ET effects in acute HF are unknown.

Objective:

To investigate the effects of ET alone or combined with noninvasive ventilation (NIV) compared with standard medical treatment during hospitalization in acute HF patients.

Methods:

Twenty-nine patients (systolic HF) were randomized into three groups: control (Control – only standard medical treatment); ET with placebo NIV (ET+Sham) and ET+NIV (NIV with 14 and 8 cmH₂O of inspiratory and expiratory pressure, respectively). The 6MWT was performed on day 1 and day 10 of hospitalization and the ET was performed on an unloaded cycle ergometer until patients’ tolerance limit (20 min or less) for eight consecutive days. For all analyses, statistical significance was set at 5% (p < 0.05).

Results:

None of the patients in either exercise groups had adverse events or required exercise interruption. The 6MWT distance was greater in ET+NIV (Δ120 ± 72 m) than in ET+Sham (Δ73 ± 26 m) and Control (Δ45 ± 32 m; p < 0.05). Total exercise time was greater (128 ± 10 vs. 92 ± 8 min; p < 0.05) and dyspnea was lower (3 ± 1 vs. 4 ± 1; p < 0.05) in ET+NIV than ET+Sham. The ET+NIV group had a shorter hospital stay (17 ± 10 days) than ET+Sham (23 ± 8 days) and Control (39 ± 15 days) groups (p < 0.05). Total exercise time in ET+Sham and ET+NIV had significant correlation with length of hospital stay (r = -0.75; p = 0.01).

Conclusion:

Exercise training in acute HF was safe, had no adverse events and, when combined with NIV, improved 6MWT and reduce dyspnea and length of stay.