The time-to-treatment concept in acute heart failure: Lessons and implications from REALITY-AHF

Özet

Acute heart failure (AHF) is a clinical syndrome with devastating prognosis. Despite considerable improvements in the treatment of chronicheart failure, most trials of new drugs for AHF, such as vasodilators, inotropes, and diuretics, have failed to show a prognostic benefit. Therefore,pharmacological treatment of AHF has changed very little, and loop diuretics have remained a cornerstone drug for decades. One of theemerging factors possibly playing an important role in AHF management is the time course of treatment. Several recent retrospective studieshave highlighted the importance of early treatment in AHF; however, at the time, support from a prospective study with an adequate number ofenrolled patients was lacking. The Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure(REALITY-AHF) was the first prospective study to specifically focus on the time course of treatment in the very acute phase and its prognosticimplication in patients with AHF. Data from the REALITY-AHF revealed that early treatment with intravenous furosemide is significantly associatedwith lower in-hospital mortality. Although pathophysiological background of this association remains to be investigated, the time courseof treatment may be a critical component of AHF treatment, and it will be important to take this factor into account in future clinical studies onAHF.