Book Review

Acute Heart Failure

N Engl J Med 2008; 359:1189-1190September 11, 2008

Article

Acute Heart Failure
Edited by Alexandre Mebazaa, Mihai Gheorghiade, Faiez M. Zannad, and Joseph E. Parrillo. 931 pp., illustrated. London, Springer, 2008. $229. ISBN: 978-1-84628-781-7

Acute heart failure is a major health issue, accounting for a large proportion of patients admitted to hospitals. Patients with recent hospitalizations for acute heart failure are at high risk for future cardiovascular events and death. In contrast to treatments for chronic heart failure, advances in the management of acute heart failure have been limited while its incidence has been increasing — the latter trend being due in part to the aging patient population and in part to the success achieved in the management of acute myocardial infarction, chronic ischemic heart disease, and hypertension. Only recently have large clinical studies and trials begun to assess the clinical characteristics, outcome, and treatment of acute heart failure. Because the care of patients with acute heart failure is managed not only by cardiologists but also by emergency medicine and intensive care physicians and anesthesiologists, broad coverage of all aspects of this increasingly common disease is warranted. In this respect, Acute Heart Failure addresses an important need.

In slightly more than 900 pages, experts discuss pathophysiology, epidemiology, diagnostic procedures, therapeutic interventions, and related issues such as respiratory and ventilation management, sepsis, and specific conditions that are occasionally associated with acute heart failure. Internationally known cardiologists and intensivists have put together a reference book for the clinician managing acute heart failure and for specialists investigating the scientific basis of all aspects of acute heart failure. The book's particular strength is the broad, in-depth discussion of clinically relevant topics, such as acute heart failure in the elderly, acute heart failure in sepsis, risk stratification, the management of fluid overload, and airway and pulmonary problems; readers will appreciate the illustrative clinical cases included in these discussions.

Some chapters do not live up to the high standard set by others in the book, in part because the separation between the material on research and that intended for practicing physicians is unclear. Chapters on agents such as endothelin antagonists, which are unlikely to go to market, are excellent but clinically almost irrelevant. Discussions of some topics (including coronary syndromes) are too short, whereas others are too long. Some of the latest technical developments, such as the Impella systems for circulatory support and recent insights into the pathophysiology of diseases such as postpartum cardiomyopathy, are not covered. Conversely, in a book focusing on acute heart failure, one could question the need to cover the basic physiology of cardiac failure in depth or to describe cellular and organ systems in experimental models that for the most part have not been applied to the treatment of acute heart failure.

Growing evidence suggests that new heart failure accounts only for 10 to 20% of patients with acutely decompensated heart failure, whereas heart failure with precipitating factors accounts for 80 to 90% of such patients. However, no chapter in this book deals with the prevention of acute heart failure through disease management programs or with the devices used to monitor intrathoracic pressures and volume. Nonetheless, this book provides the most comprehensive coverage to date of most aspects of acute heart failure available in a single volume, and its interdisciplinary approach makes it valuable to physicians caring for patients with acute heart failure. The book underscores the medical importance of acute heart failure, its economic costs, and its neglected status as a research topic. By identifying our lack of knowledge, data, and carefully performed trials, the book puts researchers, clinicians, and health care authorities on notice to include acute heart failure as a topic of major concern in future research.

Helmut Drexler, M.D.
Hannover Medical School, 30625 Hannover, Germany
drexler.helmut@mh-hannover.de