Acute heart failure (AHF) represents a potentially fatal disease that needs immediate hospital care. In-hospital management can be divided into three consecutive phases: an early phase of intensive management of symptoms, an intermediate phase of stabilization and transition from intravenous to oral medication, and a late phase of discharge and outpatient management. However, despite its life-threatening features (increased mortality and readmission rates), many treatment decisions are opinion based and only few are evidence based. The present paper describes in-hospital treating modalities and attempts to provide clinical and laboratory criteria for patient evaluation that will help doctors determine readiness and safety of discharge. In addition, it highlights some unresolved issues that need to be addressed by future research.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/ 5608938/Activity.aspx