Acute heart failure
Also known as: acute decompensated heart failure · ADHF · flash pulmonary edema
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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
AHA/ACC/HFSA · 2022
There is no standalone US guideline for acute decompensated heart failure; hospitalised and acutely decompensated presentations are addressed within this single comprehensive 2022 heart failure guideline, which covers prevention, diagnosis, chronic management and the inpatient episode together. Clinicians looking for US guidance on acute heart failure should consult the hospitalisation and transitions-of-care sections of this document. Metadata record only.
- Single comprehensive US heart failure guideline issued in 2022 by AHA, ACC and HFSA covering prevention, diagnosis and management. source
- Replaces the 2013 ACCF/AHA heart failure guideline and the 2017 focused update. source
- Evidence base drawn from a literature search through 2020 with additional trials considered through September 2021. source
2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
European Society of Cardiology (ESC) · 2023 · 2023 Focused Update of the 2021 guideline
The ESC treats acute and chronic heart failure in one guideline family. The 2021 parent document contains the main acute heart failure chapter, and this 2023 focused update revises selected acute heart failure recommendations in light of newer randomised trials. Both documents together represent the current European guidance for acute presentations. Metadata record only.
- Acute heart failure is one of the topic areas explicitly revised by the 2023 ESC focused update. source
- Issued because several randomised trials published after 2021 were judged to change management before the next full guideline cycle. source
- The 2021 ESC guideline on the diagnosis and treatment of acute and chronic heart failure remains the parent document. source
US vs EU key differences
- The 2023 ESC focused update gives dapagliflozin or empagliflozin a Class I, Level A recommendation in both HFmrEF and HFpEF — the strongest grade any drug class holds in preserved ejection fraction. source
- The 2022 US guideline is more cautious on the same drugs, grading SGLT2 inhibitors Class 2a in HFpEF and HFmrEF; it is also the document that adopted the Universal Definition four-stage (A–D) framework and the HFimpEF 'improved ejection fraction' category, which the European text does not use. source
- Finerenone entered European heart failure guidance first: the 2023 ESC update gives it a Class I recommendation to reduce heart failure hospitalisation in type 2 diabetes with chronic kidney disease, a recommendation absent from the 2022 US guideline. source
What changed recently
- EU2021 → 2023 Focused Update of the 2021 guideline2023-08-25
Following STRONG-HF, the 2023 focused update adds a Class I recommendation that patients hospitalised for heart failure have evidence-based therapy rapidly up-titrated before discharge with close follow-up over the first six weeks, replacing the more permissive post-discharge approach of the 2021 guideline.
source ↗curation confidence 90% - US2013 (with 2017 Focused Update) → 20222022-04-01
The 2022 guideline replaces the 2013 guideline and its 2017 focused update, adds SGLT2 inhibitors to standard therapy, and broadens the document with new sections on cardiac amyloidosis, cardio-oncology, comorbidity management and advanced (stage D) therapies.
source ↗curation confidence 90%
See the full update feed for changes across every system.