Future options for management of heart failure in an emergency department observation unit

In the next year there will be over 1 million United States hospitalizations for acute decompensated heart failure (ADHF), with 80% admitted to the hospital through the emergency department. The short stay Observation Unit represents a new strategy for diagnosis and treatment of ADHF. This manuscript examines some of the promising options that may become available to the practitioner in the near future. These include 1) ultrafiltration, where excess fluid is removed by the application of a minimally invasive extracorporeal blood circuit; 2) digital sound wave analysis, which provides improved specificity for the diagnosis of ADHF; 3) and intermittent infusion therapy, where initial studies suggest infusion therapy with nesiritide may improve chronic outcomes. These applications may be uniquely appropriate for the observation unit environment. While not currently mainstream or standard of care in their current usage, these opportunities may represent foreseeable directions in the early diagnosis and treatment of ADHF. Future research will place these maneuvers into their appropriate diagnostic and therapeutic roles, which will hopefully provide benefit to our patients.