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March 27, 2002

Treatment of Acute Heart Failure: Out With the Old, In With the New

Author Affiliations

Author Affiliation: Department of Cardiac Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, England.

JAMA. 2002;287(12):1578-1580. doi:10.1001/jama.287.12.1578

The phrase heart failure encompasses a variety of clinical syndromes. A simple and practical classification is acute heart failure (pulmonary edema), circulatory failure (cardiogenic shock), and chronic heart failure. Adjectives such as systolic and diastolic, overt, congestive, decompensated, undulating, treated, or compensated are commonly added to the latter syndrome. Other distinctions paraded as forward and backward, right- and left-sided, high- and low-output heart failure are rightly out of favor and limited to historical interest reflecting concepts that in large part have been shown to be incorrect. In the last few decades, there have been remarkable improvements in the treatment of chronic heart failure. The epidemiology and implications of heart failure for health care have been appreciated, understanding of the biology and physiology of heart failure has been advanced, new drugs have become available, and the progress in cardiac transplantation has been a catalyst for enthusiasm in the promotion of research.