[Worsening heart failure: definition, management and treatment]

Heart failure (HF) is a clinical syndrome with high morbidity and mortality, characterized by periods of relative clinical stability and exacerbations of HF, known as worsening heart failure (WHF). WHF is currently defined as a deterioration of HF signs and symptoms, necessitating an intensification of medical therapy, often identified by an increase in diuretic therapy. Episodes of WHF, whether they result in patient hospitalization or outpatient management, suggest clinical progression of HF with significant worsening of the prognosis. Although the prognostic impact of WHF is well documented in the literature, its current definition has limitations, and its management remains suboptimal and non-standardized, particularly in outpatient settings. Additionally, early detection of WHF episodes, preventing possible patient hospitalization, is crucial for improving prognosis and is still underemphasized in major HF clinical trials. This review aims to report the prevalence of WHF and the limitations of its current definition, and to provide suggestions for the appropriate management of WHF episodes, with a special focus on early and outpatient recognition.