Archives of the
Turkish Society of Cardiology
Expert Opinion

Pre-Discharge and Post-Discharge Management and Treatment Optimization in Acute Heart Failure

1.

Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir

2.

Başkent Üniversitesi, Kardiyoloji Anabilim Dalı, İstanbul

3.

Ege Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, İzmir

4.

Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Anabilim Dalı, Ankara

5.

Dokuz Eylül Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir

Archives of the Turkish Society of Cardiology 2022; 50: 378-394
DOI: 10.5543/tkda.2022.22329
Read: 146 Downloads: 57 Published: 01 July 2022

Acute heart failure is associated with high mortality and rehospitalization rates and required urgent evaluation and early initiation or intensification of therapy. The risk of death and heart failure rehospitalization is greatest in the early post-discharge period, particularly within the first 3-6 months, and declines over time, which is referred as a vulnerable period of acute heart failure hospitalization. Therefore, implementation of guidelines-directed optimal therapy is not only so crucial in the acute phase but also very important in the pre-discharge and early post- discharge period in reducing mortality and rehospitalization rates. The pre-discharge period represents a window of opportunity for treatment optimization which includes to eliminate congestion, to treat comorbidities or precipitating factors, and to initiate or uptitrate oral ther- apy before discharge. Early assessment in the post-discharge period based on clinical evalu- ation and laboratory exams, further optimization of disease-modifying therapy is associated with lower 30-day hospitalization for heart failure. In clinical practice, clinicians usually focus on acute phase intravenous medications and short-term device therapies and, in fact, neglect short- and long-term comprehensive approaches. This paper reviews management strategies that may help reduce mortality and heart failure rehospitalizations in pre-discharge and post- discharge periods and include adopting holistic approaches for heart failure, increasing optimi- zation of evidence-based therapies, treating cardiac and noncardiac comorbidities, improving care transitions, monitoring, and disease management.

Cite this article as: Çavuşoğlu Y, Altay H, Nalbantgil S, Temizhan A, Yılmaz MB. Pre-discharge and post-discharge management and treatment optimization in acute heart failure. 2022;50(5):378-394.

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ISSN 1016-5169 EISSN 1308-4488