Acute heart failure in emergency settings
Abstract
Abstract Acute heart failure (AHF) represents a major cause of emergency medical care worldwide and continues to carry a substantial burden of morbidity and mortality despite advances in chronic heart failure management. Most patients with AHF present to emergency departments (EDs), where the first hours of care are critical to determine prognosis. Of these, some have been previously evaluated and treated by prehospital emergency medical services before ED arrival. This consensus document summarizes the current evidence and provides practical advice to emergency physicians for the diagnosis, treatment, and disposition of patients with AHF in these emergency settings (emergency medical services and ED). It emphasizes the importance of a rapid phenotypic classification into acute decompensated heart failure, acute pulmonary oedema, isolated right ventricular failure, or cardiogenic shock, as a key tool to guide early management and triage decisions. It reviews evidence on prehospital and ED management, including the use of biomarkers, imaging, ventilatory support, diuretic and vasodilator strategies, and early initiation or continuation of guideline-directed medical therapy. It also discusses risk stratification and disposition decisions supported by validated tools. Finally, it identifies major knowledge gaps and future research priorities, including pragmatic trials to assess prehospital interventions, biomarker-guided therapy, and early initiation of disease-modifying treatments. Ultimately, this consensus document is aimed to contribute to the improvement of outcomes in AHF.
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Authors: Òscar Miró, Josep Masip, Ovidiu Chioncel, Effie Polyzogopoulou, Veli‐Pekka Harjola, Xavier Rosselló, W. Frank Peacock, Sai͏̈d Laribi, John Parissis, Christian E Müller, Wilhelm Behringer, Múcio Tavares, Guido Tavazzi, Janine Pöss, Frederik Hendrik Verbrugge, Elke Platz, Marianna Adamo, Johannes Grand, Mehmet B Yilmaz, Hannah Schaubroeck, Susanna Price, Alessandro Sionís, Alessia Gambaro, Otilia Țica, Danielle Menosi Gualandro, Alexandre Mebazaa, Mattia Arrigo
Institutions: Brigham and Women's Hospital, University of Verona, Universidade de São Paulo, Harvard University, University of Basel, University Hospital of Basel, University of Helsinki, Leipzig University, Vrije Universiteit Brussel, Rigshospitalet, Policlinico San Matteo Fondazione, Universitat Autònoma de Barcelona, Ghent University Hospital, University of Brescia, Copenhagen University Hospital, Helsinki University Hospital, Carol Davila University of Medicine and Pharmacy, Hospital de Sant Pau, Centro de Investigación Biomédica en Red, Hospital Clínic de Barcelona, Centro de Investigación en Red en Enfermedades Cardiovasculares, Universitat de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, University of Pavia, Medical University of Vienna, Baylor College of Medicine, University General Hospital Attikon, Università della Svizzera italiana, Dokuz Eylül University, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Hôpital Lariboisière, Hospital Universitario Son Espases, Université de Tours, Centre Hospitalier Universitaire de Tours, Universitair Ziekenhuis Brussel, Azienda Ospedaliera Universitaria Integrata Verona, Vienna General Hospital, Universitat de les Illes Balears, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Consorci Sanitari Garraf, Ospedale regionale di Lugano