{"id":9079,"date":"2025-10-27T21:35:25","date_gmt":"2025-10-27T18:35:25","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9079"},"modified":"2025-10-27T21:35:25","modified_gmt":"2025-10-27T18:35:25","slug":"acute-heart-failure-management-evidence-based-guidance-jcs-scientific-heart-failure-national-protocols-taskforce-session-2025","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/acute-heart-failure-management-evidence-based-guidance-jcs-scientific-heart-failure-national-protocols-taskforce-session-2025\/","title":{"rendered":"Acute Heart Failure Management \u2013 Evidence-Based Guidance (JCS Scientific Heart Failure National Protocols Taskforce Session, 2025)"},"content":{"rendered":"
Acute Heart Failure Management \u2013 Evidence-Based Guidance<\/div>\n
(JCS Scientific Heart Failure National Protocols Taskforce Session, 2025)<\/div>\n
<\/div>\n
Speaker: Dr. Aiman Hamdan, MD, FACC<\/div>\n
<\/div>\n
Keynotes :<\/div>\n
1.\u2060 \u2060Initial Stabilization and Diagnostics<\/div>\n
\u2022 Rapid triage and emergency admission \u2014 time-sensitive like ACS.<\/span><\/div>\n
\u2022 Core investigations: ECG, chest X-ray, echocardiography, BNP\/NT-proBNP, troponin, renal\/electrolyte panels.<\/span><\/div>\n
\u2022 Identify triggers: ischemia, arrhythmia, infection.<\/span><\/div>\n
\u2022 Oxygen therapy as needed \u2192 escalate to CPAP\/BiPAP or intubation in severe cases.<\/span><\/div>\n
<\/div>\n
2.\u2060 \u2060Managing Volume Overload (\u201cWet\u201d Phenotype)<\/div>\n
\u2022 IV loop diuretics: first-line; use early and above home dose; monitor renal function.<\/span><\/div>\n
\u2022 If response inadequate (24\u201348 h) \u2192 add thiazide or acetazolamide.<\/span><\/div>\n
\u2022 IV vasodilators (e.g., nitroglycerin, nitroprusside) if SBP \u2265 90 mmHg to reduce filling pressures and dyspnea.<\/span><\/div>\n
<\/div>\n
3.\u2060 \u2060Addressing Hypoperfusion (\u201cCold\u201d States)<\/div>\n
\u2022 Warm & Dry: optimize long-term therapy, address cause.<\/span><\/div>\n
\u2022 Warm & Wet: diuretics \u00b1 vasodilators.<\/span><\/div>\n
\u2022 Cold & Dry (low perfusion, not overloaded): fluid challenge \u2192 inotropes \u2192 vasopressors if refractory.<\/span><\/div>\n
\u2022 Cold & Wet: stabilize perfusion first, then cautious diuresis \u00b1 inotropes; escalate to mechanical support if unresponsive.<\/span><\/div>\n
(Flowchart illustrated on p. 2)<\/div>\n
<\/div>\n
4.\u2060 \u2060Add-On and Device-Based Therapies<\/div>\n
\u2022 Persistent symptoms despite GDMT:<\/span><\/div>\n
\u2022 Replace ACEi\/ARB \u2192 ARNi.<\/span><\/div>\n
\u2022 Add Ivabradine if HR \u2265 70 bpm in sinus rhythm on max beta-blocker.<\/span><\/div>\n
\u2022 Device options:<\/span><\/div>\n
\u2022 ICD if LVEF \u2264 35 % + life expectancy > 1 yr.<\/span><\/div>\n
\u2022 CRT for LBBB\/wide QRS.<\/span><\/div>\n
\u2022 LVAD or advanced mechanical support in Stage D \/ refractory HF.<\/span><\/div>\n
<\/div>\n
5.\u2060 \u2060Ongoing In-Hospital Care<\/div>\n
\u2022\u2060\u00a0 \u2060VTE prophylaxis for immobilized patients<\/div>\n
\u2003(IMPROVE-VTE Score:<\/div>\n
\u2003Assesses VTE risk \u2014 heart\/respiratory failure, cancer, immobility > 7 days, prior VTE, age \u2265 60, high D-dimer.<\/div>\n
\u2003\u2192 \u2265 4 points = high risk \u2192 give prophylaxis (LMWH 40 mg SC daily or UFH 5000 U SC q8\u201312 h).<\/div>\n
\u2003Validated internationally \u2014including AHA\/ACC and APSC\u2013Japan (2024 updates), which confirmed its usefulness and suggested minor recalibration for Asian populations due to lower baseline VTE rates.<\/div>\n
\u2003Developed from the U.S. IMPROVE Registry (Spyropoulos AC et al., Thromb Haemost 2016; 116: 352\u2013362 \u2013 AHA\/ACC and APSC\u2013Japan 2024 updates on validation and regional adaptation).<\/div>\n
<\/div>\n
\u2003IMPROVE-Bleed Score:<\/div>\n
\u2003Assesses bleeding risk \u2014 prior bleed, thrombocytopenia, severe renal\/liver failure, active cancer, age \u2265 85.<\/div>\n
\u2003\u2192 \u2265 7 points = high bleeding risk \u2192 avoid or shorten prophylaxis.<\/div>\n
<\/div>\n
\u2003Use both to balance clot vs. bleed risk (IMPROVE-VTE \u2265 4 and IMPROVE-Bleed < 7).<\/div>\n
\u2003Routine long-term prophylaxis after discharge is not recommended unless immobility or very high risk persists.<\/div>\n
<\/div>\n
\u2003Recommended drugs: LMWH or UFH during hospitalization; short-course oral DOACs (e.g., rivaroxaban 10 mg daily) may be considered post-discharge in selected high-risk, low-bleed patients.)<\/div>\n
<\/div>\n
\u2022\u2060\u00a0 \u2060Restart\/initiate guideline-directed medical therapies (GDMT) once stable:<\/div>\n
\u2003SGLT2 inhibitors, MRAs, ARNi\/ACEi\/ARB, beta-blockers.<\/div>\n
\u2003SGLT2i and MRAs can be started early due to minimal blood-pressure effect.<\/div>\n
<\/div>\n
6.\u2060 \u2060Pre-Discharge and Transition Strategy<\/div>\n
\u2022 Ensure complete decongestion and stable body weight.<\/span><\/div>\n
\u2022 Adjust home diuretic dose, monitor electrolytes\/renal function.<\/span><\/div>\n
\u2022 Plan rehabilitation and post-discharge uptitration of chronic HF therapy.<\/span><\/div>\n
<\/div>\n
7.\u2060 \u2060Monitoring and Long-Term Follow-up<\/div>\n
\u2022 Regular review of symptoms, labs, and biomarkers.<\/span><\/div>\n
\u2022 Patient education: self-care, daily weights, early symptom recognition.<\/span><\/div>\n
\u2022 Telemonitoring and remote follow-up reduce readmissions.<\/span><\/div>\n
<\/div>\n
8.\u2060 \u2060Comorbidities and Special Populations<\/div>\n
\u2022 Diabetes \u2192 emphasize SGLT2i and glucose control.<\/span><\/div>\n
\u2022 Renal impairment \u2192 adjust medication doses, monitor closely.<\/span><\/div>\n
\u2022 Atrial fibrillation, anemia, iron deficiency \u2192 correct as needed.<\/span><\/div>\n
<\/div>\n
9.\u2060 \u20609. Prognosis and Risk Stratification<\/div>\n
\u2022\u2060\u00a0 \u2060Use clinical risk scores (e.g., MAGGIC) and biomarkers for outcome prediction.<\/div>\n
\u2022\u2060\u00a0 \u2060Incorporate imaging parameters (echo indices) into overall risk assessment.<\/div>\n
<\/div>\n
(Additional note \u2013 MAGGIC Score)<\/div>\n
The MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) score is a validated international tool that predicts 1- and 3-year mortality risk in heart-failure patients.<\/div>\n
It integrates key variables \u2014 age, LVEF, NYHA class, systolic BP, creatinine, diabetes, smoking, BMI, medications, and etiology \u2014 to generate a simple risk estimate.<\/div>\n
<\/div>\n
\u2192 Higher score = higher predicted mortality.<\/div>\n
When combined with biomarkers (NT-proBNP, troponin) and echocardiographic measures (LVEF, LV size, strain), it provides a more comprehensive and accurate risk profile for clinical decision-making.<\/div>\n
<\/div>\n
Key Takeaway:<\/div>\n
Early recognition, structured hemodynamic profiling (\u201cwarm \/ cold, wet \/ dry\u201d), and rapid initiation of guideline-directed therapies are the pillars of improving survival and reducing rehospitalization in acute heart failure.<\/div>\n","protected":false},"excerpt":{"rendered":"

Acute Heart Failure Management \u2013 Evidence-Based Guidance (JCS Scientific Heart Failure National Protocols Taskforce Session, 2025) Speaker: Dr. Aiman Hamdan, MD, FACC Keynotes : 1.\u2060 \u2060Initial Stabilization and Diagnostics \u2022 Rapid triage and emergency admission \u2014 time-sensitive like ACS. \u2022 Core investigations: ECG, chest X-ray, echocardiography, BNP\/NT-proBNP, troponin, renal\/electrolyte panels. \u2022 Identify triggers: ischemia, arrhythmia, […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9079","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9079","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9079"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9079\/revisions"}],"predecessor-version":[{"id":9080,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9079\/revisions\/9080"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9079"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9079"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9079"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}