title: Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance.
abstract: OBJECTIVE
  Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings.
  
  
  RESULTS
  Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries.
  
  
  CONCLUSIONS
  A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.
authors.affiliation: U 942 Inserm, Paris, France. alexandre.mebazaa@aphp.fr.|University Paris Diderot, Sorbonne Paris Cité, Paris, France. alexandre.mebazaa@aphp.fr.|Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, Paris, France. alexandre.mebazaa@aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: U 942 Inserm, Paris, France.|Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Tolppanen
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Lassus
authors.affiliation: Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: DiSomma
authors.affiliation: Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
authors.forename: G
authors.initials: G
authors.lastname: Baksyte
authors.affiliation: Anaesthesia and Intensive Care, St George's Hospital and Medical School, London, SW17 0QT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Cecconi
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: D J
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: U 942 Inserm, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Paris, France.|Department of Cardiology, Hôpital Lariboisiere, APHP, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Cohen Solal
authors.affiliation: Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Christ
authors.affiliation: Department of Intensive Care Medicine, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Masip
authors.affiliation: U 942 Inserm, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Arrigo
authors.affiliation: Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Nouira
authors.affiliation: Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
authors.forename: D
authors.initials: D
authors.lastname: Ojji
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Boston, MA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Peacock
authors.affiliation: Christchurch Cardioendocrine Research Group, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Richards
authors.affiliation: Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sato
authors.affiliation: Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Cape Town, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Sliwa
authors.affiliation: Department of Cardiovascular Disease, International Clinical Research Center, University Hospital Brno, Brno, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Spinar
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
authors.forename: M B
authors.initials: MB
authors.lastname: Yilmaz
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Januzzi
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D003422:Critical Care / Q000592:standards*; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000628:therapy*
keywords: Cardiogenic shock; Emergency; Heart failure; Treatment