Early Management of Patients With Acute Heart Failure: State of the Art and Future Directions—A Consensus Document from the SAEM/HFSA Acute Heart Failure Working Group

Abstract

Heart failure (HF) afflicts nearly 6 million Americans, resulting in 1 million emergency department (ED) visits and over 1 million annual hospital discharges. The majority of inpatient admissions originate in the ED; thus, it is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics, and alternatives to hospitalization. This article discusses contemporary ED management as well as the necessary next steps for ED-based acute HF research.

The impact of emergency medical services in acute heart failure

“…In addition, guidelines recommend to use morphine in severe AHF, accompanied by anxiety and dyspnoea [2]. Patients most likely to benefit from medical therapy are those with hypertension and/or significant hypoxemia [17,19]. The frequent administrations of nitrate spray could be explained with the high prevalence of coronary artery disease.…”

Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis

“…3 With a population that continues to age, a 25% increase in heart failure prevalence is estimated by the year 2030. 4 Of those patients presenting to the ED with ADHF, over 80% are admitted to the hospital, making it the most common reason for admission and a significant financial burden on the health care system. 4 Despite the prevalence of heart failure, the standard workup for dyspneic patients in the ED is non-specific and often fails to differentiate ADHF from conditions such as chronic obstructive pulmonary disease (COPD).…”

“…4 Of those patients presenting to the ED with ADHF, over 80% are admitted to the hospital, making it the most common reason for admission and a significant financial burden on the health care system. 4 Despite the prevalence of heart failure, the standard workup for dyspneic patients in the ED is non-specific and often fails to differentiate ADHF from conditions such as chronic obstructive pulmonary disease (COPD). 5,6 This distinction is, however, essential as mismanagement has been shown to affect the morbidity and mortality of dyspneic patients negatively.…”

Hemodynamic, management, and outcomes of patients admitted to emergency department with heart failure

“…Guidelines suggest an initial treatment approach based on admission systolic blood pressure that divides patients into 3 groups (hypertensive, normotensive, and hypotensive) [30]. Identifying systolic blood pressure or heart rate as evidence of a particular pathophysiological pathway has important consequences for ED treatment.…”