Herzinsuffizienz ist die häufigste Ursache für Krankenhausaufnahmen in Deutschland.
Um dies zu vermeiden, ist die frühzeitige Identifikation von Parametern, die einer
Dekompensation vorangehen bzw. diese ankündigen, entscheidend. Der vorliegende Leitfaden
erklärt das Konzept der instabilen Herzinsuffizienz und gibt Hinweise für die umfassende
und koordinierte Behandlung mit Beginn bzw. Aufdosierung der prognostisch relevanten
Substanzklassen und, bei Herzinsuffizienz mit eingeschränkter Pumpfunktion, auch der
Therapie mit dem Stimulator der löslichen Guanylatzyklase Vericiguat.
Abstract
Heart failure is the leading cause of hospital admissions in Germany. The prevention
of hospitalizations due to heart failure has recently improved, encompassing guideline-based
basic therapy, targeted medication escalation options, and structured outpatient care
incorporating telemedicine. An early identification of parameters that precede or
indicate acute heart failure is crucial. The term “worsening heart failure” is broader
than the term “acute heart failure”. Worsening heart failure includes patients identified
through clinical examination, biochemical methods (especially natriuretic peptides),
and imaging (echocardiography, chest X-ray, lung ultrasound, computed tomography,
magnetic resonance imaging), and innovative cardiac telemonitoring. Early detection
of worsening heart failure is only beneficial if followed by appropriate management
that stabilizes heart failure, reduces mortality, and decreases hospital admissions
and emergency contacts. Dedicated guidelines for the treatment of worsening heart
failure are not yet available. It is recommended to start or up-titrate guideline-recommended
medical therapy and additionally initiate treatment with the soluble guanylate cyclase
stimulator Vericiguat in patients with heart failure with a reduced ejection fraction.
Initiation and up-titration should begin during hospitalization and should be completed
during careful follow-up within the first 6 weeks after discharge. This guide provides
recommendations for the comprehensive and coordinated treatment of worsening heart
failure, considering all these aspects which are crucial for improving patient outcomes.
Schlüsselwörter
Herzinsuffizienz - instabil - worsening heart failure
Keywords
unstable - worsening heart failure
