Despite the increased mortality and morbidity in patients with acute decompensated
heart failure (ADHF), its management has been based primarily on anecdotal experiences
and physiologic assumptions rather than on prospective randomized controlled trials.
The data on diuretics have been conflicting. Routine use of inotropes in ADHF has
been clearly associated with increased mortality and morbidity, although inotropes
seem to cause short-term clinical improvement. The safety of the different vasoactive
medications has never been adequately confirmed in prospective trials despite their
use for a long time in heart failure. Good evidence that supports the safety and efficacy
of the different medications that are routinely used in ADHF is lacking. Unless properly
designed prospective clinical trials are done to evaluate the safety of the various
ADHF regimens, clinicians might continue to be misguided by the beneficial short-term
effects at the expense of long-term mortality and morbidity.
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Article info
Footnotes
Conflict of interest: None.
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© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
