PubReading [10] - Recommendations on pre-hospital and early hospital management of acute heart failure - short version - Alexandre Mebazaa et al.

<p>Despite several critical steps forward in the management of <strong>chronic heart failure</strong> (CHF), the area of <strong>acute heart failure </strong>(AHF) has remained relatively stagnant. As stated in the updated ESC HF <strong>guidelines</strong>, clinicians responsible for managing patients with AHF must frequently make treatment decisions without adequate evidence, usually on the basis of expert opinion consensus.2 Specifically, the treatment of acute HF remains largely opinion-based with little good evidence to guide therapy. Acute heart failure is a syndrome in which emergency physicians, cardiologists, intensivists, nurses, and other healthcare providers have to cooperate to provide ‘<strong>rapid’ benefit</strong> to the patients. We hereby would like to underscore the wider experience grown in different settings of the area of intensive care on acute heart failure, actually larger and more composite than that got in specialized Care Units. The distillate of such different experiences is discussed and integrated in the present document. Hence, the authors of this consensus paper believe a common working definition of AHF covering all dimensions and modes of presentations has to be made, with the understanding that most AHF presentations are either acute decompensations of chronic underlying HF or the abrupt onset of dyspnoea associated with significantly elevated blood pressure. Secondly, recent data show that, much like acute coronary syndrome, AHF might have a ‘time to therapy’ concept. Accordingly, ‘pre-hospital’ management is considered a critical component of care. Thirdly, most patients with AHF have normal or high blood pressure at presentation and are admitted with symptoms and/or signs of congestion. This is in contradiction to the presentation where low cardiac output leads to <strong>symptomatic hypotension</strong> and <strong>signs/symptoms of hypoperfusion</strong>, a circumstance that is relatively rare, present in coronary care unit/ intensive care unit (CCU/ICU) but associated wi