Acute heart failure care - a consensus series of an international experts' group

The care of patients hospitalized for acute heart failure (AHF) has been largely unchanged from the early 1960s until a few years ago, consisting mainly of oxygen and diuretics supplemented sometimes by other vasoactive drugs. These treatments, although effective in the short term in controlling congestion, do not prevent early readmissions and death, occurring in over 30% of patients in the 6 months after an AHF hospitalization. In the last years, studies showed that AHF diagnosis can be improved, early diuretic care can be optimized, and early intensive therapy with combined drug regimens can reduce the rate of adverse outcomes. However, unlike acute coronary syndromes, where guidelines have existed since 1996, there are no separate detailed guidelines for AHF. In a series of four papers (International Expert Opinion Series on AHF Management) an international expert group highlights important aspects of AHF care where the evidence base to inform clinical practice is lacking. These papers focus on (1) diagnosis and treatment during prehospital and in the emergency department, (2) management during the first days of admission, (3) care before and after AHF discharge, and (4) hospitalized AHF management in patients presenting with cardiogenic shock, significant valvular disease, or end-stage renal disease. These papers are not intended to serve as guidelines, but rather to suggest a framework for future recommendations for the diagnosis and treatment of AHF. In the current summary paper, we highlight the main considerations and key recommendations in each of the parts of AHF care.