Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Focused Guidelines on Acute Heart Failure...

Acute heart failure in children is a complex clinical syndrome associated with significant morbidity and mortality, often requiring intensive care management and consideration of advanced therapies. The heterogeneity in presentation and limited pediatric-specific data have historically led to wide variations in care. The Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association focused guidelines on acute heart failure in children provides updated, evidence-informed recommendations to guide clinicians in diagnostic evaluation and therapeutic interventions. This focused guideline addresses 10 prioritized clinical questions and offers recommendations on the following topics: (1) use of cardiac magnetic resonance imaging; (2) prognostic use of brain natriuretic peptides, and (3) genetic testing; (4) strategies for diuretic initiation and (5) guideline-directed medical therapy; (6) choice of inotropic and vasoactive agents for acute support; (7) monitoring strategies including the role of pulmonary artery catheters; (8) timing for initiating durable ventricular assist device support; (9) the use of temporary mechanical circulatory support; and (10) indications and timing for left atrial decompression in children supported with extracorporeal membrane oxygenation. These recommendations are on the basis of systematic evidence reviews, the evidence to decision framework, and expert consensus, with detailed methodology and supporting evidence provided in Supplementary material S1-S11.