The Modern Aspects of Acute Heart Failure Management

  • Sergiy Fedorov Ivano-Frankivsk National Medical University
  • Nataliya Izhytska Lviv National Medical University named after Danylo Halytsky
  • Tomasz Kulpok-Baginski High School of Strategic Planning in Dąbrowa Górnicza
  • Klaudiusz Nadolny High School of Strategic Planning in Dąbrowa Górnicza
Keywords: acute heart failure, management


Acute heart failure (AHF) is one the most common causes of morbidity and mortality. The prognosis of patients admitted with AHF remains dismal, with over 20% experiencing recurrent HF admission and over 20% dying during the first year after initial admission.

The purpose of this study was to provide contemporary perspective for hospital management of AHF within the context of the most recent data and to provide guidance, based on expert opinions, to practicing physicians and other healthcare professionals.

Material and methods: In this paper we reviewed of current updated European Cardiology Society (ESC) HF guideline (2016) and modern trials for AHF from Medscape database.

Results: Diuretics are the main medications in the treatment of patients with AHF and signs of fluid overload and congestion. Intravenous vasodilators are the second most used agent in AHF. Their use was shown to be associated with lower mortality, and a delay in administration was associated with a higher mortality.Use of an inotropic medications (such as dopamine, dobutamine, milrinone, levosimendan, epinephrine, norepenephrine) should be reserved for patients with a severe reduction in cardiac output resulting in compromised vital organ perfusion, which occurs most often in hypotensive AHF.

Conclusion: Acute heart failure is a life-threatening medical condition, which needs emergency management for death prevention.


Ponikowski P, Anker SD, Alhabib K, et al. Heart failure. Preventing disease and death worldwide. ESC. 2014;

Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93:1137–1146. DOI: [PMCid: PMC1955040][PMid: 17699180]

Bleumink GS, Knetsch AM, Sturkenboom MCJM, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J England. 2004;25:1614–1619. DOI: [PMid: 15351160]

Harjola V-P, Bueno H, Parissis JT. Current Approach to Heart Failure. Springer. 2016;485–507. DOI:

Damasceno A, Mayosi BM, Sani M, et al. The causes, treatment, and outcomes of acute heart failure in 1006 Africans from 9 countries: results from Sub-Saharan African Survey of Heart Failure. Arch Int Med. 2012;172:1386–1394. DOI: [PMid: 22945249]

Dzudie A, Milo O, Edwards C, et al. Prognostic significance of ECG abnormalities in acute heart failure insight from Sub-Saharan African Survey of Heart Failure. J Card Fail. 2014;20:45–52. DOI: [PMid: 24269854]

Al-Shamiri MQ. Heart failure in the Middle East. Curr Cardiol Rev. 2013;9:112–122. DOI: [PMCid: PMC3682400]

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–2200. DOI: [PMid: 27206819]

Mebezaa A, Yilmaz MB, Levy P, et al. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015;17:544–558. DOI: [PMid: 25999021]

Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41:1797–1804. DOI:

Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967;20:457–464. DOI:

Cox ZL, Lenihan DJ. Loop diuretic resistance in heart failure: resistance etiology-based strategies to restoring diuretic efficacy. J Card Fail. 2014;20:611–622. DOI: [PMid: 24879974]

Peacock WF, Emerman C, Costanzo MR, et al. Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail. 2009;15(6):256–264. DOI: [PMid: 19925503]

Mebazaa A, Nieminen MS, Filippatos GS, et al. Levosimendan vs. dobutamine: outcomes for acute heart failure patients on β-blockers in SURVIVE. Eur J Heart Fail. 2009;11:304–311. DOI: [PMCid: PMC2645051][PMid: 19158152]

Gong B, Li Z, Yat Wong PC. Levosimendan treatment for heart failure: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2015;29:1415–1425. DOI: [PMid: 26275522]

Peacock WF, Hollander JE, Diercks DB, et al. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg Med J. 2008;25(4):205–209. DOI: [PMid: 18356349]

Fonarow GC, Heywood JT, Heidenreich PA, et al. Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2007;153(6):1021–1028. DOI: [PMid: 17540205]

Natella PA, Le Corvisier P, Paillaud E, et al. Long-term mortality in older patients discharged after acute decompensated heart failure: a prospective cohort study. BMC Geriatr. 2017;17:34 DOI: [PMCid: PMC5270303][PMid: 28125958]