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J Card Fail. 2015 Jan;21(1):27-43. doi: 10.1016/j.cardfail.2014.07.003. Epub 2014 Jul 18.

Early management of patients with acute heart failure: state of the art and future directions. A consensus document from the society for academic emergency medicine/heart failure society of America acute heart failure working group.

Author information

1
Nashville Veterans Affairs Medical Center and Vanderbilt University, Nashville, Tennessee. Electronic address: sean.collins@vanderbilt.edu.
2
Vanderbilt University, Nashville, Tennessee.
3
Cleveland Clinic, Cleveland, Ohio.
4
Emory University, Atlanta, Georgia.
5
University of Alberta, Edmonton, Alberta, Canada.
6
Duke University, Durham, North Carolina.
7
University of Cincinnati, Cincinnati, Ohio.
8
Ronald Reagan-UCLA Medical Center, Los Angeles, California.
9
Harvard Medical School, Boston, Massachusetts.
10
Wake Forest University, Winston-Salem, North Carolina.
11
Thomas Jefferson University, Philadelphia, Pennsylvania.
12
Henry Ford Hospital, Detroit, Michigan.
13
Wayne State University, Detroit, Michigan.
14
Indiana University School of Medicine, Indianapolis, Indiana.
15
Baylor College of Medicine, Houston, Texas.
16
San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California.

Abstract

Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). 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. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition decisions cannot be underestimated. Predictive instruments that identify a cohort of patients safe for ED discharge, while simultaneously addressing barriers to successful outpatient management, have the potential to significantly impact quality of life and resource expenditures.

KEYWORDS:

Acute heart failure; early management; emergency medicine

PMID:
25042620
PMCID:
PMC4276508
DOI:
10.1016/j.cardfail.2014.07.003
[Indexed for MEDLINE]
Free PMC Article

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