Acute decompensated heart failure: Formulating an evidence-based approach to diagnosis and treatment (Part I)

Heart failure is a disease that affects approximately 5 million Americans, accounts for 1 million hospitalizations annually, and represents the most common hospital discharge diagnosis for patients over the age of 65. Despite the significant impact of this disease, the accepted approach to treatment of acute decompensated heart failure (ADHF) has changed little in over 40 years. Another potential problem is that differentiating ADHF from other causes of dyspnea can be difficult, as historical elements, physical examination findings, and radiographic results lack adequate sensitivities to accurately identify the disease. This article, the first of a two-part series, will explore the historically accepted disease models for heart failure and their relevance to developing a therapeutic approach to ADHF. Additionally, diagnostic issues in heart failure will be examined, particularly the emerging role of natriuretic peptide assays for the identification of ADHF.