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Time-to-treatment Concept in Acute Heart Failure: Lessons and Implications from the REALITY-AHF [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-88935 | DOI: 10.14744/AnatolJCardiol.2018.88935  

Time-to-treatment Concept in Acute Heart Failure: Lessons and Implications from the REALITY-AHF

Nobuyuki Kagiyama1,21, Yuya Matsue3,42
1Division of Cardiology, Washington University in St. Louis, St. Louis, MO, USA
2Department of Cardiology, The Sakakaibara Heart Institute of Okayama, Okayama, Japan
3Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
4Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

Acute heart failure (AHF) is a clinical syndrome with a devastating prognosis. Despite dramatic improvements in the treatment of chronic heart failure, most trials of new drugs for AHF, such as vasodilators, inotropes, diuretics, etc., have failed to show a prognostic benefit. Accordingly, the pharmacological treatment of AHF has changed very little, and loop diuretics have remained a cornerstone drug for decades. One of the emerging factors possibly playing an important role in AHF management is the time course of the treatment. Several recent retrospective studies have highlighted the importance of early treatment in AHF; however, at the time, support from a prospective study with an adequate number of enrolled patients was lacking. The Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure (REALITY-AHF) study was the first prospective study to focus specifically on the time course of treatment in the very acute phase and its prognostic implication in patients with AHF. Data from the REALITY-AHF showed that early treatment with intravenous furosemide is significantly associated with lower in-hospital mortality. Although the pathophysiological background of this association has yet to be investigated, the time course of the treatment may be a critical component of AHF treatment, and it will be important to take this factor into account in future clinical studies on AHF.

Keywords: Acute heart failure, prognosis, diuretics, renal function, congestion


Time-to-treatment Concept in Acute Heart Failure: Lessons and Implications from the REALITY-AHF

Nobuyuki Kagiyama1,21, Yuya Matsue3,42
1Division of Cardiology, Washington University in St. Louis, St. Louis, MO, USA
2Department of Cardiology, The Sakakaibara Heart Institute of Okayama, Okayama, Japan
3Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
4Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

Acute heart failure (AHF) is a clinical syndrome with a devastating prognosis. Despite dramatic improvements in the treatment of chronic heart failure, most trials of new drugs for AHF, such as vasodilators, inotropes, diuretics, etc., have failed to show a prognostic benefit. Accordingly, the pharmacological treatment of AHF has changed very little, and loop diuretics have remained a cornerstone drug for decades. One of the emerging factors possibly playing an important role in AHF management is the time course of the treatment. Several recent retrospective studies have highlighted the importance of early treatment in AHF; however, at the time, support from a prospective study with an adequate number of enrolled patients was lacking. The Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure (REALITY-AHF) study was the first prospective study to focus specifically on the time course of treatment in the very acute phase and its prognostic implication in patients with AHF. Data from the REALITY-AHF showed that early treatment with intravenous furosemide is significantly associated with lower in-hospital mortality. Although the pathophysiological background of this association has yet to be investigated, the time course of the treatment may be a critical component of AHF treatment, and it will be important to take this factor into account in future clinical studies on AHF.

Anahtar Kelimeler: Acute heart failure, prognosis, diuretics, renal function, congestion




Corresponding Author: Yuya Matsue3,4, Türkiye


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