title: Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes.
abstract: Guideline recommendations for the prehospital and early in-hospital (first 6-12 hrs after presentation) management of acute heart failure syndromes are lacking. The American College of Cardiology/American Heart Association and European Society of Cardiology guidelines direct the management of these acute heart failure patients, but specific consensus on early management has not been published, primarily because few early management trials have been conducted. This article summarizes practical recommendations for the prehospital and early management of patients with acute heart failure syndromes; the recommendations were developed from a meeting of experts in cardiology, emergency medicine, and intensive care medicine from Europe and the United States. The recommendations are based on a unique clinical classification system considering the initial systolic blood pressure and other symptoms: 1) dyspnea and/or congestion with systolic blood pressure >140 mm Hg; 2) dyspnea and/or congestion with systolic blood pressure 100-140 mm Hg; 3) dyspnea and/or congestion with systolic blood pressure <100 mm Hg; 4) dyspnea and/or congestion with signs of acute coronary syndrome; and 5) isolated right ventricular failure. These practical recommendations are not intended to replace existing guidelines. Rather, they are meant to serve as a tool to facilitate guideline implementation where data are available and to provide suggested treatment approaches where formal guidelines and definitive evidence are lacking.
authors.affiliation: Hôpital Lariboisière APHP, University Paris 7 Diderot, Paris, France. alexandre.mebazaa@lrb.aphp.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Steven M
authors.initials: SM
authors.lastname: Hollenberg
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.forename: Patrick
authors.initials: P
authors.lastname: Plaisance
authors.forename: Edmond
authors.initials: E
authors.lastname: Roland
authors.forename: Markku
authors.initials: M
authors.lastname: Nieminen
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Alexander
authors.initials: A
authors.lastname: Parkhomenko
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D004417:Dyspnea / Q000209:etiology; D004632:Emergency Medical Services; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents