These are the current NICE guidance for patients presenting with Acute Heart Failure(AHF). The problem with these guidelines is the definition of AHF. No mention of whether AHF is the same as ADHF (decompensated) but I’m guessing they are commenting on patients who present early with mild symptoms of heart failure. But for arguments sake, because Emergency Physicians are hammers and this looks like a nice enough nail, I thought I’d dress up as hammer and discuss this.
Diuretics as the main stay again?Then there is also the negative wording with regards to nitrates and NIV.
Haven’t we been through this already?
Patients with AHF are symptomatic because of pulmonary and or systemic congestion and end organ dysfunction from decreased cardiac output.
Furosemide will reduce preload via diuresis, but most of these patients are already clinically dry. Besides the fact that you need to have a functioning kidney to ultrafiltrate out the fluid, loop diuretics have a long duration of action (i.e. 2hours and longer), it is not an easily titratable drug as compared to nitrates. It is hard to ignore the continuous fear of hypokalemia and its complications from high dose loop diuretics.
NIV with PEEP saves lives. The data is there. This should not even come up in 2014.