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2023 SFMU/GICC-SFC/SFGG expert recommendations for the emergency management of older patients with acute heart failure. Part 1: Prehospital management and diagnosis
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Edité par CCSD ; Elsevier ; Société française de cardiologie [2008-....] -
International audience. Acute heart failure (AHF) is a complex, multifactorial syndromic condition that, until now, did not have a consensual definition [1], [2]. The difficulties in agreeing on a consensual definition of AHF also apply to research, since depending on the application of the field of investigation, the target populations concerned and the therapeutic goals or pathophysiological knowledge sought, the elements defining heart failure (HF) vary, especially among older patients. Thus, although the advent of echocardiography has made it possible to characterize disturbances in myocardial relaxation and altered ventricular filling, marking the birth of the concept of HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF), the different clinical presentations do not always make it possible to determine whether myocardial failure corresponds to a disease of ventricular filling of vascular origin [3].AHF is most often characterized by dyspnoea, lower limb oedema and/or intense asthenia. It is a common presentation in emergency departments (EDs) and has become a major public health problem as its incidence and prevalence rise in line with an aging population in all developed countries. AHF represents a growing medico-economic burden and is associated with high morbidity and mortality [4]. Currently, AHF is the main reason for hospital admissions in patients aged > 65 years and acute cardiogenic pulmonary oedema accounts for approximately 1% of ED visits [3], [4], involving approximately 200,000 patients per year in France (including 5% of the French population aged 75–85 years and 10% of those aged > 85 years) [5]. HF is a progressive pathology linked to aging, with mortality rising by 10% each year [6]. Indeed, the mortality rate remains appalling, reaching up to 12% during the hospital stay, 8–20% in the 2 months following hospitalization for an episode of AHF, and reaching 25–50% in the first 5 years after initial diagnosis. Moreover, mortality is increased in the presence of associated comorbidities such as anaemia, hypercholesterolemia or renal dysfunction, all of which become more frequent with age [3], [4], [6], [7].
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