ABSTRACT
Acute heart failure (AHF) refers to new onset or decompensation of chronic signs and symptoms of heart failure (HF) requiring unscheduled care or hospital admission. Hospitalization for AHF is associated with high rates of morbidity, rehospitalization, and mortality. The immediate goals of AHF care are early diagnosis, identification of precipitants that need urgent management (e.g., acute coronary syndrome), clinical stabilization, and treatment to improve symptoms. Appropriate emergency department triage and identification of patients who require intensive care are pivotal. Monitoring of respiratory status and provision of ventilatory support, if necessary, while implementing decongestion strategies, are critical initial steps in the management of AHF. Use of diuretics and combinations of diuretics is fundamental for decongestion. For patients with elevated blood pressure, vasodilators are a cornerstone of AHF therapy. However, for patients with hypotension and/or cardiogenic shock, use of inotropic agents and vasopressors is required; refractory cases are candidates for mechanical circulatory support measures, which are discussed in the next chapter. Management of concomitant comorbidities, e.g., atrial fibrillation, and prophylaxis for venous thromboembolism, are important strategies to optimize AHF outcomes. In-hospital monitoring of congestion status, readiness for discharge, and appropriate follow-up after hospitalization for AHF are still areas of active investigation.
