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Updated: Jun 1, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Acute heart failure: lessons learned so far
1Department of Cardiac Sciences, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada. jonathan.howlett@cdha.nshealth.ca
Insights
Acute heart failure (AHF) impacts many Canadians, with diagnosis shifting to outpatient settings. Current interventions focus on care processes, not new drugs, to improve outcomes for this complex condition.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Acute heart failure (AHF) is a common and serious condition affecting many Canadians with heart failure (HF).
- The diagnosis of AHF is increasingly occurring in outpatient settings, presenting new challenges.
- Existing medical therapies have not improved the long-term prognosis of AHF.
Purpose of the Study:
- To review recent literature on AHF presentation, diagnosis, management, and prognosis.
- To identify critical lessons learned from registry data and clinical trials regarding AHF.
- To provide guidelines for improving AHF treatment and highlight research priorities.
Main Methods:
- Review of recent literature on acute heart failure.
- Analysis of registry data and clinical trial findings.
- Synthesis of information on AHF presentation, diagnosis, management, and prognosis.
Main Results:
- AHF is a dynamic syndrome with a potentially prolonged pre-clinical instability phase.
- Early and accurate diagnosis of AHF is crucial for patient outcomes.
- Standard care involves early diuretics, with vasodilators and oxygen for selected patients.
- Survivors of AHF face high rates of re-presentation, death, and rehospitalization.
- Effective interventions focus on care processes rather than novel medications or devices.
Conclusions:
- AHF requires further intensive study, offering opportunities for research and innovation.
- Improving care processes is key to enhancing outcomes for patients with AHF.
- Guidelines are provided to improve the treatment and management of AHF.
Abstract:
Acute heart failure (AHF) affects nearly every Canadian with heart failure (HF) at least once. Despite several attempts, no medical therapies have been shown to improve the natural history of AHF. In addition, the place of diagnosis of AHF is increasingly made in the outpatient setting. In this view, AHF is a moving target, and from recent registry data and from clinical trials, 5 critical lessons regarding the syndrome of AHF emerge: (1) The period of clinical instability preceding AHF may be much longer than previously thought. (2) Refinement of tools used to aid the early and accurate diagnosis of AHF will impact patient outcomes. (3) Standard supportive care of patients with AHF includes early use of diuretics with frequent reassessment in nearly all patients and supplemental vasodilators and oxygen therapy in selected cases. (4) Patients who survive presentation of AHF continue to suffer high rates of re-presentation, death, and rehospitalization following discharge from either hospital or emergency department. (5) Interventions shown to improve patient outcomes for AHF to date are related to process of care rather than new medications or devices. This report reviews the recent literature regarding the presentation, diagnosis, management, and prognosis of AHF. Areas of future research priority are indicated and guidelines for improving treatment are provided. AHF is an important clinical area that has not been as intensively studied as chronic HF; it presents both important needs and exciting opportunities for research and innovation.
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