title: Early management of patients with acute heart failure: state of the art and future directions. A consensus document from the society for academic emergency medicine/heart failure society of America acute heart failure working group.
abstract: Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition decisions cannot be underestimated. Predictive instruments that identify a cohort of patients safe for ED discharge, while simultaneously addressing barriers to successful outpatient management, have the potential to significantly impact quality of life and resource expenditures.
authors.affiliation: Nashville Veterans Affairs Medical Center and Vanderbilt University, Nashville, Tennessee. Electronic address: sean.collins@vanderbilt.edu.
authors.forename: Sean
authors.initials: S
authors.lastname: Collins
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Ezekowitz
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.affiliation: University of Cincinnati, Cincinnati, Ohio.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.affiliation: Ronald Reagan-UCLA Medical Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.affiliation: Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Brian
authors.initials: B
authors.lastname: Hiestand
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: Henry Ford Hospital, Detroit, Michigan.
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.affiliation: Wayne State University, Detroit, Michigan.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Sawyer
authors.affiliation: San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lenihan
mesh_terms: D000208:Acute Disease; D019468:Disease Management; D004635:Emergency Medicine / Q000592:standards / Q000639:trends*; D005544:Forecasting; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000592:standards / Q000639:trends; D012955:Societies, Medical / Q000592:standards / Q000639:trends*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Acute heart failure; early management; emergency medicine