Acute heart failure in emergency settings
Abstract Acute heart failure (AHF) represents a major cause of emergency medical care worldwide and continues to carry a substantial burden of morbidity and mortality despite advances in chronic heart failure management. Most patients with AHF present to emergency departments (EDs), where the first hours of care are critical to determine prognosis. Of these, some have been previously evaluated and treated by prehospital emergency medical services before ED arrival. This consensus document summarizes the current evidence and provides practical advice to emergency physicians for the diagnosis, treatment, and disposition of patients with AHF in these emergency settings (emergency medical services and ED). It emphasizes the importance of a rapid phenotypic classification into acute decompensated heart failure, acute pulmonary oedema, isolated right ventricular failure, or cardiogenic shock, as a key tool to guide early management and triage decisions. It reviews evidence on prehospital and ED management, including the use of biomarkers, imaging, ventilatory support, diuretic and vasodilator strategies, and early initiation or continuation of guideline-directed medical therapy. It also discusses risk stratification and disposition decisions supported by validated tools. Finally, it identifies major knowledge gaps and future research priorities, including pragmatic trials to assess prehospital interventions, biomarker-guided therapy, and early initiation of disease-modifying treatments. Ultimately, this consensus document is aimed to contribute to the improvement of outcomes in AHF.
Authors
- Susanna Price (ORCID: https://orcid.org/0000-0002-6425-3360)
- W. Frank Peacock (ORCID: https://orcid.org/0000-0002-2730-6742)
- Johannes Grand (ORCID: https://orcid.org/0000-0002-5511-4668)
- Otilia Țica (ORCID: https://orcid.org/0000-0002-6019-122X)
- Frederik Hendrik Verbrugge (ORCID: https://orcid.org/0000-0003-0599-9290)
- Xavier Rosselló (ORCID: https://orcid.org/0000-0001-6783-8463)
- Alessandro Sionís (ORCID: https://orcid.org/0000-0003-0843-9512)
- Alessia Gambaro (ORCID: https://orcid.org/0000-0001-8341-1427)
- Guido Tavazzi (ORCID: https://orcid.org/0000-0002-9560-5138)
- Mattia Arrigo (ORCID: https://orcid.org/0000-0003-4028-2869)
- Hannah Schaubroeck (ORCID: https://orcid.org/0000-0002-5219-4834)
- Josep Masip (ORCID: https://orcid.org/0000-0002-8612-9889)
- Veli‐Pekka Harjola (ORCID: https://orcid.org/0000-0001-5351-0811)
- Elke Platz (ORCID: https://orcid.org/0000-0002-8604-0710)
- Ovidiu Chioncel (ORCID: https://orcid.org/0000-0002-3197-3628)
- Janine Pöss (ORCID: https://orcid.org/0009-0004-2177-3085)
- Marianna Adamo (ORCID: https://orcid.org/0000-0002-3855-1815)
- Wilhelm Behringer (ORCID: https://orcid.org/0000-0003-2261-3193)
- Sai͏̈d Laribi (ORCID: https://orcid.org/0000-0003-4648-4672)
- Alexandre Mebazaa (ORCID: https://orcid.org/0000-0001-8715-7753)
- Óscar Miró (ORCID: https://orcid.org/0000-0001-8127-166X)
- Danielle Menosi Gualandro (ORCID: https://orcid.org/0000-0001-9041-6250)
- John Parissis (ORCID: https://orcid.org/0000-0001-5375-1789)
- Múcio Tavares
- Mehmet B Yilmaz
- Christian E Müller
- Effie Polyzogopoulou
Institutions
- Université de Tours (FR)
- University of Verona (IT)
- Universitat Autònoma de Barcelona (ES)
- Brigham and Women's Hospital (US)
- University of Helsinki (FI)
- Vrije Universiteit Brussel (BE)
- Harvard University (US)
- Carol Davila University of Medicine and Pharmacy (RO)
- Universidade de São Paulo (BR)
- Baylor College of Medicine (US)
- University of Basel (CH)
- Dokuz Eylül University (TR)
- University of Pavia (IT)
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- Helsinki University Hospital (FI)
- Ghent University Hospital (BE)
- Hospital de Sant Pau (ES)
- Vienna General Hospital (AT)
- University Hospital of Basel (CH)
- Copenhagen University Hospital (DK)
- Rigshospitalet (DK)
- Harefield Hospital (GB)
- Ospedale regionale di Lugano (CH)
- Azienda Ospedaliera Universitaria Integrata Verona (IT)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (ES)
- Centre Hospitalier Universitaire de Tours (FR)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Centro de Investigación Biomédica en Red (ES)
- Hospital Clínic de Barcelona (ES)
- Hôpital Lariboisière (FR)
- Universitair Ziekenhuis Brussel (BE)
- University General Hospital Attikon (GR)
- Policlinico San Matteo Fondazione (IT)
- Hospital Universitario Son Espases (ES)
- Consorci Sanitari Garraf (ES)
- Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
- Universitat de les Illes Balears (ES)
- Università della Svizzera italiana (CH)
- Universitat de Barcelona (ES)
- Medical University of Vienna (AT)
- University of Brescia (IT)
- Leipzig University (DE)
Publication Details
- Journal
- European Heart Journal
- Published
- 2026-10-22
- DOI
- https://doi.org/10.1093/eurheartj/ehag744
- Primary Topic
- Heart Failure Treatment and Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00