Early diagnosis and treatment of acute heart failure in prehospital and emergency settings. Part 1 of the International Expert Opinion Series on acute heart failure management

Acute heart failure (AHF) is diagnosed in about 0.5% of all patients seen by emergency medical systems (EMS) and represents about 1% of emergency department (ED) visits. Leg swelling and shortness of breath are the most frequent patient complaints. Despite significant advancements in patient care pathways, the proper diagnosis, treatment and disposition of AHF may be further improved in emergency settings. The present document is an expert consensus document outlining key points in diagnosis, treatment and decision-making of patients being diagnosed with AHF by EMS and in the ED. Pillars of correct diagnosis include detailed clinical assessment and accurate interpretation of natriuretic peptides, while chest X-ray is still the most frequent image test used in ED, that could be substituted by ultrasonography exploration in appropriate patients. Quick identification of the most severe cases needing intensive care is mandatory, most of them characterized by hemodynamic instability, ventilatory failure or acute coronary syndrome needing intervention. Treatment could be started in prehospital settings by EMS, and loop diuretics are still the cornerstone of decongestive therapy. Measurement of diuresis and natriuresis shortly after provision of the first diuretic bolus is recommended, as it can help in detecting patients with poor diuretic response for dose augmentation or drug escalation with the addition of acetazolamide or thiazides. For selected patients, vasodilators (especially for acute cardiogenic pulmonary edema phenotype) or inotropes/vasopressors (for those with cardiogenic shock) can be needed. Oxygen therapy should be provided to patients with air-room SpO 2 below 95%, and noninvasive ventilation is an option for patients with respiratory distress. After provision of ED care, a correct decision of patient discharge or hospitalization is paramount, and risk stratification can help in this regard. Other key points of AHF management in the ED include adequate diagnosis and management of triggers of the AHF episode; to take aspects of patient frailty into account; to avoid lines, catheters, and patient overstay in the ED where possible; and to ensure a proper follow-up plan after discharge from the hospital.

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Publication Details

Journal
European Journal of Emergency Medicine
Published
2025-09-28
DOI
https://doi.org/10.1097/mej.0000000000001270
Citations
3
Primary Topic
Sepsis Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
4.06
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article

Early diagnosis and treatment of acute heart failure in prehospital and emergency settings. Part 1 of the International Expert Opinion Series on acute heart failure management

Mauro Riccardi, Karen Sliwa‐Hahnle, Siti E. Nauli, Gianluigi Savarese et al.
3 citations
European Journal of Emergency Medicine
Sepsis Diagnosis and Treatment
4.06
article

Early diagnosis and treatment of acute heart failure in prehospital and emergency settings. Part 1 of the International Expert Opinion Series on acute heart failure management

Mauro Riccardi, Karen Sliwa‐Hahnle, Siti E. Nauli, Gianluigi Savarese, Andrew P. Ambrosy, Anastase Dzudié, Jingmin Zhou, Yonathan Freund, Edimar Alcides Bocchi, Marat Fudim, Ovidiu Chioncel, Ivna G C V Lima, Gad Cotter, Jan Biegus, Javed Butler, Matteo Pagnesi, Yuhui Zhang, Naoki Sato, Sivadasanpillai Harikrishnan, Òscar Miró, Alex Mebazaa, Beth Davison, Robert J Mentz
article en
3 citations

Abstract

Acute heart failure (AHF) is diagnosed in about 0.5% of all patients seen by emergency medical systems (EMS) and represents about 1% of emergency department (ED) visits. Leg swelling and shortness of breath are the most frequent patient complaints. Despite significant advancements in patient care pathways, the proper diagnosis, treatment and disposition of AHF may be further improved in emergency settings. The present document is an expert consensus document outlining key points in diagnosis, treatment and decision-making of patients being diagnosed with AHF by EMS and in the ED. Pillars of correct diagnosis include detailed clinical assessment and accurate interpretation of natriuretic peptides, while chest X-ray is still the most frequent image test used in ED, that could be substituted by ultrasonography exploration in appropriate patients. Quick identification of the most severe cases needing intensive care is mandatory, most of them characterized by hemodynamic instability, ventilatory failure or acute coronary syndrome needing intervention. Treatment could be started in prehospital settings by EMS, and loop diuretics are still the cornerstone of decongestive therapy. Measurement of diuresis and natriuresis shortly after provision of the first diuretic bolus is recommended, as it can help in detecting patients with poor diuretic response for dose augmentation or drug escalation with the addition of acetazolamide or thiazides. For selected patients, vasodilators (especially for acute cardiogenic pulmonary edema phenotype) or inotropes/vasopressors (for those with cardiogenic shock) can be needed. Oxygen therapy should be provided to patients with air-room SpO 2 below 95%, and noninvasive ventilation is an option for patients with respiratory distress. After provision of ED care, a correct decision of patient discharge or hospitalization is paramount, and risk stratification can help in this regard. Other key points of AHF management in the ED include adequate diagnosis and management of triggers of the AHF episode; to take aspects of patient frailty into account; to avoid lines, catheters, and patient overstay in the ED where possible; and to ensure a proper follow-up plan after discharge from the hospital.

European Journal of Emergency MedicineVol. 32(6)
Université de Yaoundé I (CM), Kaiser Permanente (US), Inserm (FR), University of Cape Town (ZA), Sun Yat-sen University (CN), Carol Davila University of Medicine and Pharmacy (RO), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Université Paris Cité (FR), Fudan University (CN), Sree Chitra Thirunal Institute for Medical Sciences and Technology (IN), Karolinska Institutet (SE), University of Indonesia (ID), University of Mississippi (US), Wroclaw Medical University (PL), Sorbonne Université (FR), Clinical Research Institute (US), Sorbonne Paris Cité (FR), Stockholm South General Hospital (SE), Assistance Publique – Hôpitaux de Paris (FR), Surgical Specialties (Canada) (CA), Universitas Muhammadiyah Tangerang (ID), Geriatric Research Education and Clinical Center (US), Baylor Medical Center at Garland (US), Hospital Clínic de Barcelona (ES), Hôpital Lariboisière (FR), South African Heart Association (ZA), Pitié-Salpêtrière Hospital (FR), Kaiser Permanente San Francisco Medical Center (US), Zhongshan Hospital (CN), The First Affiliated Hospital, Sun Yat-sen University (CN), Momentum Research (US), Noguchi Hospital (JP), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Duke University Hospital (US), Research Institute of Dallas (US), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Fu Wai Hospital (CN), Istituti Ospitalieri di Cremona (IT), Universitat de Barcelona (ES), University of Brescia (IT)
Openalex Percentile: Top 6%
Sepsis Diagnosis and Treatment
4.06
DOISourceOpenAlex
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