[Unstable heart failure: practical guidelines for avoiding frequent hospital admissions]

Heart failure is the leading cause of hospital admissions in Germany. The prevention of hospitalizations due to heart failure has recently improved, encompassing guideline-based basic therapy, targeted medication escalation options, and structured outpatient care incorporating telemedicine. An early identification of parameters that precede or indicate acute heart failure is crucial. The term "worsening heart failure" is broader than the term "acute heart failure". Worsening heart failure includes patients identified through clinical examination, biochemical methods (especially natriuretic peptides), and imaging (echocardiography, chest X-ray, lung ultrasound, computed tomography, magnetic resonance imaging), and innovative cardiac telemonitoring. Early detection of worsening heart failure is only beneficial if followed by appropriate management that stabilizes heart failure, reduces mortality, and decreases hospital admissions and emergency contacts. Dedicated guidelines for the treatment of worsening heart failure are not yet available. It is recommended to start or up-titrate guideline-recommended medical therapy and additionally initiate treatment with the soluble guanylate cyclase stimulator Vericiguat in patients with heart failure with a reduced ejection fraction. Initiation and up-titration should begin during hospitalization and should be completed during careful follow-up within the first 6 weeks after discharge. This guide provides recommendations for the comprehensive and coordinated treatment of worsening heart failure, considering all these aspects which are crucial for improving patient outcomes.