Congestive heart failure AHA recommendations for hospitalized patient: Difference between revisions

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{{Infobox_Disease |
__NOTOC__
  Name          = Heart failure |
{| class="infobox" style="float:right;"
  Image          = |
|-
  Caption        = |
| [[File:Siren.gif|30px|link= Congestive heart failure resident survival guide]]|| <br> || <br>
  DiseasesDB    = 16209 |
| [[Acute decompensated heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  ICD10          = {{ICD10|I|50|0|i|50}} |
|}
  ICD9          = {{ICD9|428.0}} |
{| class="infobox" style="float:right;"
  ICDO          = |
|-
  OMIM          = |
| [[File:Critical_Pathways.gif|88px|link= Congestive heart failure critical pathways]]|| <br> || <br>
  MedlinePlus    = 000158 |
|}
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D006333|
}}
{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}; {{AE}} {{MS}} [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] [Mailto:efco@alum.up.edu.ph]


{{CMG}}; {{AOEIC}} {{LG}}
==2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==


==Overview==
===PATIENTS HOSPITALIZED WITH ACUTE DECOMPENSATED HF 2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===


==ACC/AHA Guidelines- For the Hospitalized Patient (DO NOT EDIT) <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
===Assessment of Patients Hospitalized With Decompensated HF (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
{{cquote| 
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
'''1.''' The diagnosis of [[heart failure]] is primarily based on signs and symptoms derived from a thorough [[Congestive heart failure history and symptoms|history]] and [[Congestive heart failure physical examination|physical examination]]. Clinicians should determine the following:
:'''a.''' adequacy of systemic perfusion;
:'''b.''' volume status;
:'''c.''' the contribution of precipitating factors and/or comorbidities;
:'''d.''' if the [[heart failure]] is new onset or an exacerbation of chronic disease; and
:'''e.''' whether it is associated with preserved [[ejection fraction]].


[[Congestive heart failure chest x ray|Chest radiographs]], [[Congestive heart failure electrocardiogram|electrocardiogram]], and [[Congestive heart failure echocardiography|echocardiography]] are key tests in this assessment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] [[hospitalized]] with [[HF]], [[severity]] of [[congestion]] and adequacy of [[perfusion]] should be assessed to guide [[triage]] and initial [[therapy]]. <ref name="pmid19675681">{{cite journal| author=Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD | display-authors=etal| title=Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial. | journal=Circ Heart Fail | year= 2008 | volume= 1 | issue= 3 | pages= 170-7 | pmid=19675681 | doi=10.1161/CIRCHEARTFAILURE.108.769778 | pmc=2724723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19675681  }} </ref> <ref name="pmid31127678">{{cite journal| author=Chioncel O, Mebazaa A, Maggioni AP, Harjola VP, Rosano G, Laroche C | display-authors=etal| title=Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry. | journal=Eur J Heart Fail | year= 2019 | volume= 21 | issue= 11 | pages= 1338-1352 | pmid=31127678 | doi=10.1002/ejhf.1492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31127678  }} </ref><ref name="pmid24281134">{{cite journal| author=Cleland JG, Chiswell K, Teerlink JR, Stevens S, Fiuzat M, Givertz MM | display-authors=etal| title=Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study. | journal=Circ Heart Fail | year= 2014 | volume= 7 | issue= 1 | pages= 76-87 | pmid=24281134 | doi=10.1161/CIRCHEARTFAILURE.113.000284 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24281134  }} </ref><ref name="pmid23293303">{{cite journal| author=Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B | display-authors=etal| title=Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial. | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 11 | pages= 835-43 | pmid=23293303 | doi=10.1093/eurheartj/ehs444 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23293303  }} </ref><ref name="pmid31526538">{{cite journal| author=Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J | display-authors=etal| title=2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 15 | pages= 1966-2011 | pmid=31526538 | doi=10.1016/j.jacc.2019.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31526538  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''2.''' Concentrations of [[BNP|B-type natriuretic peptide]] ([[BNP]]) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) should be measured in patients being evaluated for [[dyspnea]] in which the contribution of [[heart failure]] is not known. Final diagnosis requires interpreting these results in the context of all available clinical data and ought not to be considered a stand alone test.<ref name="pmid12124404">{{cite journal |author=Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA |title=Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure |journal=[[The New England Journal of Medicine]] |volume=347 |issue=3 |pages=161–7 |year=2002 |month=July |pmid=12124404 |doi=10.1056/NEJMoa020233 |url=http://dx.doi.org/10.1056/NEJMoa020233 |accessdate=2012-04-06}}</ref><ref name="pmid17548729">{{cite journal |author=Moe GW, Howlett J, Januzzi JL, Zowall H |title=N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVE-CHF study |journal=[[Circulation]] |volume=115 |issue=24 |pages=3103–10 |year=2007 |month=June |pmid=17548729 |doi=10.1161/CIRCULATIONAHA.106.666255 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17548729 |accessdate=2012-04-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In [[patients]] [[hospitalized]] with [[HF]], the common [[precipitating factors]] and the overall [[patient]] trajectory should be assessed to guide appropriate [[therapy]]. <ref name="pmid31526538">{{cite journal| author=Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J | display-authors=etal| title=2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 15 | pages= 1966-2011 | pmid=31526538 | doi=10.1016/j.jacc.2019.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31526538  }} </ref><ref name="pmid27256749">{{cite journal| author=Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF | display-authors=etal| title=Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 6 | pages= 464-72 | pmid=27256749 | doi=10.1016/j.jchf.2016.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27256749  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''3.''' [[Acute coronary syndrome]] precipitating [[heart failure]] hospitalization should be promptly identified by [[Congestive heart failure electrocardiogram|electrocardiogram]] and [[Troponin#Diagnostic Use|cardiac troponin testing]], and treated, as appropriate to the overall condition and prognosis of the patient. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' For [[patients]] admitted with [[HF]], [[treatment]] should address reversible factors, establish optimal volume status, and advance GDMT toward targets for [[outpatient]] [[therapy]].<ref name="pmid27256749">{{cite journal| author=Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF | display-authors=etal| title=Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 6 | pages= 464-72 | pmid=27256749 | doi=10.1016/j.jchf.2016.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27256749  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
|}


'''4.''' It is recommended that the following common potential precipitating factors for [[HF|acute HF]] be identified as recognition of these comorbidities is critical to guide therapy: ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
===Maintenance or Optimization of GDMT During Hospitalization (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
:'''a.''' [[acute coronary syndromes]]/[[ischemia|coronary ischemia]];
:'''b.''' severe [[hypertension]];
:'''c.''' [[atrial arrhythmias|atrial]] and [[ventricular arrhythmias]];
:'''d.''' infections;
:'''e.''' [[pulmonary emboli]];
:'''f.''' [[renal failure]]; and
:'''g.''' medical or dietary noncompliance.  


'''5.''' Oxygen therapy should be administered to relieve symptoms related to [[hypoxemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]] requiring [[hospitalization]], preexisting GDMT should be continued and optimized to improve outcomes, unless contraindicated. <ref name="pmid18617067">{{cite journal| author=Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH | display-authors=etal| title=Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 3 | pages= 190-9 | pmid=18617067 | doi=10.1016/j.jacc.2008.03.048 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617067  }} </ref><ref name="pmid28189999">{{cite journal| author=Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD | display-authors=etal| title=Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction. | journal=J Am Heart Assoc | year= 2017 | volume= 6 | issue= 2 | pages=  | pmid=28189999 | doi=10.1161/JAHA.116.004675 | pmc=5523765 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28189999  }} </ref><ref name="pmid25129066">{{cite journal| author=Maisel A, Xue Y, van Veldhuisen DJ, Voors AA, Jaarsma T, Pang PS | display-authors=etal| title=Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study). | journal=Am J Cardiol | year= 2014 | volume= 114 | issue= 5 | pages= 737-42 | pmid=25129066 | doi=10.1016/j.amjcard.2014.05.062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25129066  }} </ref><ref name="pmid26251094">{{cite journal| author=Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S| title=Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis. | journal=JACC Heart Fail | year= 2015 | volume= 3 | issue= 8 | pages= 647-53 | pmid=26251094 | doi=10.1016/j.jchf.2015.03.008 | pmc=4777602 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26251094  }} </ref><ref name="pmid29423950">{{cite journal| author=Tran RH, Aldemerdash A, Chang P, Sueta CA, Kaufman B, Asafu-Adjei J | display-authors=etal| title=Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure. | journal=Pharmacotherapy | year= 2018 | volume= 38 | issue= 4 | pages= 406-416 | pmid=29423950 | doi=10.1002/phar.2091 | pmc=5902433 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29423950  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''6.''' Whether the diagnosis of [[heart failure]] is new or chronic, patients who present with rapid decompensation and [[hypoperfusion]] associated with decreasing urine output and other manifestations of [[shock]] are critically ill and rapid intervention should be used to improve systemic perfusion. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In [[patients]] experiencing mild decrease of [[renal function]] or [[asymptomatic]] reduction of blood pressure during [[HF]] [[hospitalization]], [[diuresis]] and other GDMT should not routinely be discontinued. <ref name="pmid30738978">{{cite journal| author=Peri-Okonny PA, Mi X, Khariton Y, Patel KK, Thomas L, Fonarow GC | display-authors=etal| title=Target Doses of Heart Failure Medical Therapy and Blood Pressure: Insights From the CHAMP-HF Registry. | journal=JACC Heart Fail | year= 2019 | volume= 7 | issue= 4 | pages= 350-358 | pmid=30738978 | doi=10.1016/j.jchf.2018.11.011 | pmc=6440823 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30738978  }} </ref><ref name="pmid28158398">{{cite journal| author=Böhm M, Young R, Jhund PS, Solomon SD, Gong J, Lefkowitz MP | display-authors=etal| title=Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF. | journal=Eur Heart J | year= 2017 | volume= 38 | issue= 15 | pages= 1132-1143 | pmid=28158398 | doi=10.1093/eurheartj/ehw570 | pmc=6251522 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28158398  }} </ref><ref name="pmid25044535">{{cite journal| author=Montero-Perez-Barquero M, Flather M, Roughton M, Coats A, Böhm M, Van Veldhuisen DJ | display-authors=etal| title=Influence of systolic blood pressure on clinical outcomes in elderly heart failure patients treated with nebivolol: data from the SENIORS trial. | journal=Eur J Heart Fail | year= 2014 | volume= 16 | issue= 9 | pages= 1009-15 | pmid=25044535 | doi=10.1002/ejhf.136 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25044535  }} </ref><ref name="pmid19808268">{{cite journal| author=Anand IS, Rector TS, Kuskowski M, Thomas S, Holwerda NJ, Cohn JN| title=Effect of baseline and changes in systolic blood pressure over time on the effectiveness of valsartan in the Valsartan Heart Failure Trial. | journal=Circ Heart Fail | year= 2008 | volume= 1 | issue= 1 | pages= 34-42 | pmid=19808268 | doi=10.1161/CIRCHEARTFAILURE.107.736975 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19808268  }} </ref><ref name="pmid29352071">{{cite journal| author=Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco-Bacik MA, Chen HH | display-authors=etal| title=Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury. | journal=Circulation | year= 2018 | volume= 137 | issue= 19 | pages= 2016-2028 | pmid=29352071 | doi=10.1161/CIRCULATIONAHA.117.030112 | pmc=6066176 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29352071  }} </ref><ref name="pmid25808849">{{cite journal| author=Brunner-La Rocca HP, Knackstedt C, Eurlings L, Rolny V, Krause F, Pfisterer ME | display-authors=etal| title=Impact of worsening renal function related to medication in heart failure. | journal=Eur J Heart Fail | year= 2015 | volume= 17 | issue= 2 | pages= 159-68 | pmid=25808849 | doi=10.1002/ejhf.210 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25808849  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''7.''' Patients admitted with [[heart failure]] and with evidence of significant [[fluid overload]] should be treated with intravenous [[Congestive heart failure diuretics|loop diuretics]]. Therapy should begin in the emergency department or outpatient clinic without delay, as early intervention may be associated with better outcomes for patients hospitalized with decompensated [[heart failure]]. <ref name="pmid18158472">{{cite journal |author=Mebazaa A, Gheorghiade M, Piña IL, Harjola VP, Hollenberg SM, Follath F, Rhodes A, Plaisance P, Roland E, Nieminen M, Komajda M, Parkhomenko A, Masip J, Zannad F, Filippatos G |title=Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes |journal=[[Critical Care Medicine]] |volume=36 |issue=1 Suppl |pages=S129–39 |year=2008 |month=January |pmid=18158472 |doi=10.1097/01.CCM.0000296274.51933.4C |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=36&issue=1&spage=S129 |accessdate=2012-04-06}}</ref><ref name="pmid17643575">{{cite journal |author=Costanzo MR, Johannes RS, Pine M, Gupta V, Saltzberg M, Hay J, Yancy CW, Fonarow GC |title=The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database |journal=[[American Heart Journal]] |volume=154 |issue=2 |pages=267–77 |year=2007 |month=August |pmid=17643575 |doi=10.1016/j.ahj.2007.04.033 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00357-2 |accessdate=2012-04-06}}</ref><ref name="pmid17408803">{{cite journal |author=Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS |title=Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes |journal=[[Annals of Emergency Medicine]] |volume=49 |issue=5 |pages=627–69 |year=2007 |month=May |pmid=17408803 |doi=10.1016/j.annemergmed.2006.10.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(06)02461-9 |accessdate=2012-04-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' If patients are already receiving [[Congestive heart failure diuretics|loop diuretic therapy]], the initial intravenous dose should equal or exceed their chronic oral daily dose. Urine output and signs and symptoms of congestion should be serially assessed, and diuretic dose should be titrated accordingly to relieve symptoms and to reduce extracellular fluid volume excess. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''In [[patients]] with [[HFrEF]], GDMT should be initiated during [[hospitalization]] after [[clinical]] stability is achieved.<ref name="pmid28189999">{{cite journal| author=Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD | display-authors=etal| title=Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction. | journal=J Am Heart Assoc | year= 2017 | volume= 6 | issue= 2 | pages=  | pmid=28189999 | doi=10.1161/JAHA.116.004675 | pmc=5523765 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28189999  }} </ref><ref name="pmid25129066">{{cite journal| author=Maisel A, Xue Y, van Veldhuisen DJ, Voors AA, Jaarsma T, Pang PS | display-authors=etal| title=Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study). | journal=Am J Cardiol | year= 2014 | volume= 114 | issue= 5 | pages= 737-42 | pmid=25129066 | doi=10.1016/j.amjcard.2014.05.062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25129066  }} </ref><ref name="pmid29423950">{{cite journal| author=Tran RH, Aldemerdash A, Chang P, Sueta CA, Kaufman B, Asafu-Adjei J | display-authors=etal| title=Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure. | journal=Pharmacotherapy | year= 2018 | volume= 38 | issue= 4 | pages= 406-416 | pmid=29423950 | doi=10.1002/phar.2091 | pmc=5902433 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29423950  }} </ref><ref name="pmid17174643">{{cite journal| author=Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH | display-authors=etal| title=Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: an analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). | journal=Am Heart J | year= 2007 | volume= 153 | issue= 1 | pages= 82.e1-11 | pmid=17174643 | doi=10.1016/j.ahj.2006.10.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17174643  }} </ref><ref name="pmid19130987">{{cite journal| author=Hernandez AF, Hammill BG, O'Connor CM, Schulman KA, Curtis LH, Fonarow GC| title=Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. | journal=J Am Coll Cardiol | year= 2009 | volume= 53 | issue= 2 | pages= 184-92 | pmid=19130987 | doi=10.1016/j.jacc.2008.09.031 | pmc=3513266 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19130987  }} </ref><ref name="pmid25554369">{{cite journal| author=Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD | display-authors=etal| title=Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure. | journal=Am J Med | year= 2015 | volume= 128 | issue= 7 | pages= 715-21 | pmid=25554369 | doi=10.1016/j.amjmed.2014.11.036 | pmc=6756434 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25554369  }} </ref><ref name="pmid27262781">{{cite journal| author=Sanam K, Bhatia V, Bajaj NS, Gaba S, Morgan CJ, Fonarow GC | display-authors=etal| title=Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure. | journal=Am J Med | year= 2016 | volume= 129 | issue= 10 | pages= 1067-73 | pmid=27262781 | doi=10.1016/j.amjmed.2016.05.008 | pmc=5039055 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27262781  }} </ref><ref name="pmid23188026">{{cite journal| author=Hernandez AF, Mi X, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA | display-authors=etal| title=Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. | journal=JAMA | year= 2012 | volume= 308 | issue= 20 | pages= 2097-107 | pmid=23188026 | doi=10.1001/jama.2012.14795 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23188026  }} </ref><ref name="pmid33200892">{{cite journal| author=Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK | display-authors=etal| title=Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. | journal=N Engl J Med | year= 2021 | volume= 384 | issue= 2 | pages= 117-128 | pmid=33200892 | doi=10.1056/NEJMoa2030183 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33200892  }} </ref><ref name="pmid30415601">{{cite journal| author=Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K | display-authors=etal| title=Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 6 | pages= 539-548 | pmid=30415601 | doi=10.1056/NEJMoa1812851 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30415601  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''8.''' Effect of [[heart failure]] treatment should be monitored with careful measurement of fluid intake and output; vital signs; body weight, determined at the same time each day; clinical signs (supine and standing) and symptoms of systemic perfusion and congestion. Daily [[electrolytes|serum electrolytes]], [[urea nitrogen]], and [[creatinine]] concentrations should be measured during the use of [[Congestive heart failure diuretics|IV diuretics]] or active titration of [[heart failure]] medications. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''In [[patients]] with [[HFrEF]], if discontinuation of GDMT is necessary during [[hospitalization]], it should be reinitiated and further optimized as soon as possible. <ref name="pmid30025570">{{cite journal| author=Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI | display-authors=etal| title=Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. | journal=J Am Coll Cardiol | year= 2018 | volume= 72 | issue= 4 | pages= 351-366 | pmid=30025570 | doi=10.1016/j.jacc.2018.04.070 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30025570  }} </ref><ref name="pmid27123917">{{cite journal| author=Deschaseaux C, McSharry M, Hudson E, Agrawal R, Turner SJ| title=Treatment Initiation Patterns, Modifications, and Medication Adherence Among Newly Diagnosed Heart Failure Patients: A Retrospective Claims Database Analysis. | journal=J Manag Care Spec Pharm | year= 2016 | volume= 22 | issue= 5 | pages= 561-71 | pmid=27123917 | doi=10.18553/jmcp.2016.22.5.561 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27123917  }} </ref><ref name="pmid32805181">{{cite journal| author=Wirtz HS, Sheer R, Honarpour N, Casebeer AW, Simmons JD, Kurtz CE | display-authors=etal| title=Real-World Analysis of Guideline-Based Therapy After Hospitalization for Heart Failure. | journal=J Am Heart Assoc | year= 2020 | volume= 9 | issue= 16 | pages= e015042 | pmid=32805181 | doi=10.1161/JAHA.119.015042 | pmc=7660806 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32805181  }} </ref><ref name="pmid30844480">{{cite journal| author=Greene SJ, Fonarow GC, DeVore AD, Sharma PP, Vaduganathan M, Albert NM | display-authors=etal| title=Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 19 | pages= 2365-2383 | pmid=30844480 | doi=10.1016/j.jacc.2019.02.015 | pmc=7197490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30844480  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
|}


'''9.''' When [[diuresis]] is inadequate to relieve congestion, as evidenced by clinical evaluation, the diuretic regimen should be intensified using either: ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
===[[Diuretics]] in [[Hospitalized Patients]]: Decongestion Strategy (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
:'''a.''' higher doses of [[Congestive heart failure diuretics#Loop Diuretics|loop diuretics]];
:'''b.''' addition of a second diuretic (such as [[Congestive heart failure aldosterone antagonists|metolazone]], [[Congestive heart failure aldosterone antagonists|spironolactone]] or intravenous [[Congestive heart failure diuretics#Thiazide Diuretics|chlorothiazide]]); or
:'''c.''' continuous infusion of a [[Congestive heart failure diuretics#Loop Diuretics|loop diuretic]].


'''10.''' In patients with clinical evidence of [[hypotension]] associated with [[hypoperfusion]] and obvious evidence of elevated cardiac filling pressures (e.g., elevated [[jugular venous pressure]]; elevated [[Pulmonary capillary wedge pressure|pulmonary artery wedge pressure]]), intravenous [[Congestive heart failure positive inotropics|inotropic or vasopressor drugs]] should be administered to maintain systemic perfusion and preserve end organ performance while more definitive therapy is considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Patients]] with [[HF]] admitted with evidence of significant fluid overload should be promptly treated with [[intravenous]] [[loop diuretics]] to improve [[symptoms]] and reduce [[morbidity]]. Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute
decompensated heart failure. N Engl J Med. 2011;364:797–805. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''11.''' [[Congestive heart failure invasive monitoring|Invasive hemodynamic monitoring]] should be performed to guide therapy in patients who are in [[respiratory distress]] or with clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For [[patients]] [[hospitalized]] with [[HF]], [[therapy]] with [[diuretics]] and other guideline-directed [[medications]] should be titrated with a goal to resolve [[clinical]] evidence of [[congestion]] to reduce [[symptoms]] and [[rehospitalizations]]. <ref name="pmid30844480">{{cite journal| author=Greene SJ, Fonarow GC, DeVore AD, Sharma PP, Vaduganathan M, Albert NM | display-authors=etal| title=Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 19 | pages= 2365-2383 | pmid=30844480 | doi=10.1016/j.jacc.2019.02.015 | pmc=7197490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30844480  }} </ref><ref name="pmid16204662">{{cite journal| author=Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G | display-authors=etal| title=Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. | journal=JAMA | year= 2005 | volume= 294 | issue= 13 | pages= 1625-33 | pmid=16204662 | doi=10.1001/jama.294.13.1625 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16204662  }} </ref><ref name="pmid23131078">{{cite journal| author=Bart BA, Goldsmith SR, Lee KL, Givertz MM, O'Connor CM, Bull DA | display-authors=etal| title=Ultrafiltration in decompensated heart failure with cardiorenal syndrome. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 24 | pages= 2296-304 | pmid=23131078 | doi=10.1056/NEJMoa1210357 | pmc=3690472 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23131078  }} </ref><ref name="pmid29544928">{{cite journal| author=Rubio-Gracia J, Demissei BG, Ter Maaten JM, Cleland JG, O'Connor CM, Metra M | display-authors=etal| title=Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. | journal=Int J Cardiol | year= 2018 | volume= 258 | issue=  | pages= 185-191 | pmid=29544928 | doi=10.1016/j.ijcard.2018.01.067 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29544928  }} </ref><ref name="pmid23293303">{{cite journal| author=Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B | display-authors=etal| title=Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial. | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 11 | pages= 835-43 | pmid=23293303 | doi=10.1093/eurheartj/ehs444 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23293303  }} </ref><ref name="pmid31127678">{{cite journal| author=Chioncel O, Mebazaa A, Maggioni AP, Harjola VP, Rosano G, Laroche C | display-authors=etal| title=Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry. | journal=Eur J Heart Fail | year= 2019 | volume= 21 | issue= 11 | pages= 1338-1352 | pmid=31127678 | doi=10.1002/ejhf.1492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31127678  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''12.''' Medications should be reconciled in every patient and adjusted as appropriate on admission to and discharge from the hospital. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''For [[patients]] requiring [[diuretic]] [[treatment]] during [[hospitalization]] for [[HF]], the discharge regimen should include a plan for adjustment of [[diuretics]] to decrease [[rehospitalizations]].<ref name="pmid32762901">{{cite journal| author=Faselis C, Arundel C, Patel S, Lam PH, Gottlieb SS, Zile MR | display-authors=etal| title=Loop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure. | journal=J Am Coll Cardiol | year= 2020 | volume= 76 | issue= 6 | pages= 669-679 | pmid=32762901 | doi=10.1016/j.jacc.2020.06.022 | pmc=9067440 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32762901  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''13.''' In patients with [[EF|reduced ejection fraction]] experiencing a symptomatic exacerbation of [[heart failure]] requiring hospitalization during chronic maintenance treatment with oral therapies known to improve outcomes, particularly [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ACE inhibitors]] or [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ARBs]] and [[Congestive heart failure beta blockers|beta blocker therapy]], it is recommended that these therapies be continued in most patients in the absence of hemodynamic instability or contraindications. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''In [[patients]] with [[HF]] when [[diuresis]] is inadequate to relieve [[symptoms]] and [[signs]] of [[congestion]], it is reasonable to intensify the [[diuretic]] regimen using either: a. higher [[doses]] of [[intravenous]] [[loop diuretics]] <ref name="pmid21366472">{{cite journal| author=Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR | display-authors=etal| title=Diuretic strategies in patients with acute decompensated heart failure. | journal=N Engl J Med | year= 2011 | volume= 364 | issue= 9 | pages= 797-805 | pmid=21366472 | doi=10.1056/NEJMoa1005419 | pmc=3412356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21366472  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21768571 Review in: Ann Intern Med. 2011 Jul 19;155(2):JC1-5] </ref><ref name="pmid23131078">{{cite journal| author=Bart BA, Goldsmith SR, Lee KL, Givertz MM, O'Connor CM, Bull DA | display-authors=etal| title=Ultrafiltration in decompensated heart failure with cardiorenal syndrome. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 24 | pages= 2296-304 | pmid=23131078 | doi=10.1056/NEJMoa1210357 | pmc=3690472 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23131078  }} </ref>); or b. addition of a second diuretic. <ref name="pmid23131078">{{cite journal| author=Bart BA, Goldsmith SR, Lee KL, Givertz MM, O'Connor CM, Bull DA | display-authors=etal| title=Ultrafiltration in decompensated heart failure with cardiorenal syndrome. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 24 | pages= 2296-304 | pmid=23131078 | doi=10.1056/NEJMoa1210357 | pmc=3690472 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23131078  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
|}


'''14.''' In patients hospitalized with [[heart failure]] with [[EF|reduced ejection fraction]] not treated with oral therapies known to improve outcomes, particularly [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ACE inhibitors]] or [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ARBs]] and [[Congestive heart failure beta blockers|beta blocker therapy]], initiation of these therapies is recommended in stable patients prior to hospital discharge. <ref name="pmid17581778">{{cite journal |author=Metra M, Torp-Pedersen C, Cleland JG, Di Lenarda A, Komajda M, Remme WJ, Dei Cas L, Spark P, Swedberg K, Poole-Wilson PA |title=Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET |journal=[[European Journal of Heart Failure]] |volume=9 |issue=9 |pages=901–9 |year=2007 |month=September |pmid=17581778 |doi=10.1016/j.ejheart.2007.05.011 |url=http://eurjhf.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17581778 |accessdate=2012-04-06}}</ref><ref name="pmid18617067">{{cite journal |author=Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Sun JL, Yancy CW, Young JB |title=Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program |journal=[[Journal of the American College of Cardiology]] |volume=52 |issue=3 |pages=190–9 |year=2008 |month=July |pmid=18617067 |doi=10.1016/j.jacc.2008.03.048 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)01503-9 |accessdate=2012-04-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
====[[Parenteral]] [[Vasodilation]] [[Therapy]] in [[Patients]] [[Hospitalized]] With [[HF]] (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= | issue= | pages= | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>====


'''15.''' Initiation of [[Congestive heart failure beta blockers|beta blocker therapy]] is recommended after optimization of volume status and successful discontinuation of intravenous [[Congestive heart failure diuretics|diuretics]], [[Congestive heart failure vasodilators|vasodilators]], and [[Congestive heart failure positive inotropics|inotropic agents]]. [[Congestive heart failure beta blockers|Beta-blocker therapy]] should be initiated at a low dose and only in stable patients. Particular caution should be used when initiating [[Congestive heart failure beta blockers|beta blockers]] in patients who have required [[Congestive heart failure positive inotropics|inotropes]] during their hospital course. <ref name="pmid17581778">{{cite journal |author=Metra M, Torp-Pedersen C, Cleland JG, Di Lenarda A, Komajda M, Remme WJ, Dei Cas L, Spark P, Swedberg K, Poole-Wilson PA |title=Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET |journal=[[European Journal of Heart Failure]] |volume=9 |issue=9 |pages=901–9 |year=2007 |month=September |pmid=17581778 |doi=10.1016/j.ejheart.2007.05.011 |url=http://eurjhf.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17581778 |accessdate=2012-04-06}}</ref><ref name="pmid18617067">{{cite journal |author=Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Sun JL, Yancy CW, Young JB |title=Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program |journal=[[Journal of the American College of Cardiology]] |volume=52 |issue=3 |pages=190–9 |year=2008 |month=July |pmid=18617067 |doi=10.1016/j.jacc.2008.03.048 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)01503-9 |accessdate=2012-04-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In [[patients]] who are admitted with decompensated [[HF]], in the absence of [[systemic]] [[hypotension]], [[intravenous]] [[nitroglycerin]] or [[nitroprusside]] may be considered as an [[adjuvant]] to [[diuretic therapy]] for relief of [[dyspnea]]. <ref name="pmid11911755">{{cite journal| author=Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF)| title=Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. | journal=JAMA | year= 2002 | volume= 287 | issue= 12 | pages= 1531-40 | pmid=11911755 | doi=10.1001/jama.287.12.1531 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11911755  }} </ref><ref name="pmid14583355">{{cite journal| author=Cioffi G, Stefenelli C, Tarantini L, Opasich C| title=Hemodynamic response to intensive unloading therapy (furosemide and nitroprusside) in patients >70 years of age with left ventricular systolic dysfunction and decompensated chronic heart failure. | journal=Am J Cardiol | year= 2003 | volume= 92 | issue= 9 | pages= 1050-6 | pmid=14583355 | doi=10.1016/j.amjcard.2003.07.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14583355  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''16.''' In all patients hospitalized with [[heart failure]], both with preserved and low [[ejection fraction]], transition should be made from intravenous to oral [[Congestive heart failure diuretics|diuretic therapy]] with careful attention to oral diuretic dosing and monitoring of [[electrolytes]]. With all medication changes, the patient should be monitored for supine and upright [[hypotension]], [[renal dysfunction|worsening renal function]] and [[heart failure]] [[Congestive heart failure physical examination|signs]]/[[Congestive heart failure history and symptoms|symptoms]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|}


'''17.''' Comprehensive written discharge instructions for all patients with a hospitalization for [[heart failure]] and their caregivers is strongly recommended, with special emphasis on the following 6 aspects of care: diet, discharge medications, with a special focus on adherence, persistence, and uptitration to recommended doses of [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ACE inhibitor]]/[[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ARB]] and [[Congestive heart failure beta blockers|beta blocker]] medication, activity level, follow-up appointments, daily weight monitoring, and what to do if [[heart failure]] symptoms worsen. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
====[[VTE]] [[Prophylaxis]] in [[Hospitalized Patients]] (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>====


'''18.''' Postdischarge systems of care, if available, should be used to facilitate the transition to effective outpatient care for patients hospitalized with [[heart failure]]. <ref name="pmid15312864">{{cite journal |author=McAlister FA, Stewart S, Ferrua S, McMurray JJ |title=Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=4 |pages=810–9 |year=2004 |month=August |pmid=15312864 |doi=10.1016/j.jacc.2004.05.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01123-4 |accessdate=2012-04-06}}</ref><ref name="pmid15381518">{{cite journal |author=Lappé JM, Muhlestein JB, Lappé DL, Badger RS, Bair TL, Brockman R, French TK, Hofmann LC, Horne BD, Kralick-Goldberg S, Nicponski N, Orton JA, Pearson RR, Renlund DG, Rimmasch H, Roberts C, Anderson JL |title=Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program |journal=[[Annals of Internal Medicine]] |volume=141 |issue=6 |pages=446–53 |year=2004 |month=September |pmid=15381518 |doi= |url= |accessdate=2012-04-06}}</ref><ref name="pmid8185149">{{cite journal |author=Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M |title=Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial |journal=[[Annals of Internal Medicine]] |volume=120 |issue=12 |pages=999–1006 |year=1994 |month=June |pmid=8185149 |doi= |url= |accessdate=2012-04-06}}</ref><ref name="pmid15086645">{{cite journal |author=Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS |title=Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial |journal=[[Journal of the American Geriatrics Society]] |volume=52 |issue=5 |pages=675–84 |year=2004 |month=May |pmid=15086645 |doi=10.1111/j.1532-5415.2004.52202.x |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2004&volume=52&issue=5&spage=675 |accessdate=2012-04-06}}</ref><ref name="pmid12816174">{{cite journal |author=Windham BG, Bennett RG, Gottlieb S |title=Care management interventions for older patients with congestive heart failure |journal=[[The American Journal of Managed Care]] |volume=9 |issue=6 |pages=447–59; quiz 460–1 |year=2003 |month=June |pmid=12816174 |doi= |url=http://www.ajmc.com/pubMed.php?pii=11 |accessdate=2012-04-06}}</ref><ref name="pmid15026403">{{cite journal |author=Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR |title=Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis |journal=[[JAMA : the Journal of the American Medical Association]] |volume=291 |issue=11 |pages=1358–67 |year=2004 |month=March |pmid=15026403 |doi=10.1001/jama.291.11.1358 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15026403 |accessdate=2012-04-06}}</ref><ref name="pmid15642765">{{cite journal |author=Koelling TM, Johnson ML, Cody RJ, Aaronson KD |title=Discharge education improves clinical outcomes in patients with chronic heart failure |journal=[[Circulation]] |volume=111 |issue=2 |pages=179–85 |year=2005 |month=January |pmid=15642765 |doi=10.1161/01.CIR.0000151811.53450.B8 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15642765 |accessdate=2012-04-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] [[hospitalized]] with [[HF]], [[prophylaxis]] for [[VTE]] is recommended to prevent [[venous thromboembolic]] [[disease]]. <ref name="pmid12679756">{{cite journal| author=Kleber FX, Witt C, Vogel G, Koppenhagen K, Schomaker U, Flosbach CW | display-authors=etal| title=Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. | journal=Am Heart J | year= 2003 | volume= 145 | issue= 4 | pages= 614-21 | pmid=12679756 | doi=10.1067/mhj.2003.189 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12679756  }} </ref><ref name="pmid23388003">{{cite journal| author=Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R | display-authors=etal| title=Rivaroxaban for thromboprophylaxis in acutely ill medical patients. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 6 | pages= 513-23 | pmid=23388003 | doi=10.1056/NEJMoa1111096 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23388003  }} </ref><ref name="pmid24970782">{{cite journal| author=Mebazaa A, Spiro TE, Büller HR, Haskell L, Hu D, Hull R | display-authors=etal| title=Predicting the risk of venous thromboembolism in patients hospitalized with heart failure. | journal=Circulation | year= 2014 | volume= 130 | issue= 5 | pages= 410-8 | pmid=24970782 | doi=10.1161/CIRCULATIONAHA.113.003126 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970782  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
|}
'''1.''' When patients present with acute [[heart failure]] and known or suspected [[MI|acute myocardial ischemia]] due to occlusive coronary disease, especially when there are signs and symptoms of inadequate systemic perfusion, urgent [[Congestive heart failure cardiac catheterization|cardiac catheterization]] and revascularization is reasonable where it is likely to prolong meaningful survival. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


'''2.''' In patients with evidence of severely symptomatic [[fluid overload]] in the absence of systemic [[hypotension]], [[Congestive heart failure vasodilators|vasodilators]] such as intravenous [[nitroglycerin]], [[nitroprusside]] or [[nesiritide]] can be beneficial when added to [[Congestive heart failure diuretics|diuretics]] and/or in those who do not respond to diuretics alone. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
===Evaluation and [[Management]] of [[Cardiogenic Shock]] (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===


'''3.''' [[Congestive heart failure invasive monitoring|Invasive hemodynamic monitoring]] can be useful for carefully selected patients with acute [[heart failure]] who have persistent symptoms despite empiric adjustment of standard therapies, and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable" style="width:80%"
:'''a.''' whose fluid status, perfusion, or systemic or pulmonary vascular resistances are uncertain,
|-
:'''b.''' whose systolic pressure remains low, or is associated with symptoms, despite initial therapy,
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
:'''c.''' whose [[renal dysfunction|renal function is worsening]] with therapy
|-
:'''d.''' who require parenteral [[Congestive heart failure positive inotropics|vasoactive agents]] or
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[cardiogenic shock]], [[intravenous]] [[inotropic]] support should be used to maintain [[systemic]] [[perfusion]] and preserve end-organ performance.<ref name="pmid34347952">{{cite journal| author=Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T | display-authors=etal| title=Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. | journal=N Engl J Med | year= 2021 | volume= 385 | issue= 6 | pages= 516-525 | pmid=34347952 | doi=10.1056/NEJMoa2026845 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34347952  }} </ref><ref name="pmid20200382">{{cite journal| author=De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C | display-authors=etal| title=Comparison of dopamine and norepinephrine in the treatment of shock. | journal=N Engl J Med | year= 2010 | volume= 362 | issue= 9 | pages= 779-89 | pmid=20200382 | doi=10.1056/NEJMoa0907118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20200382  }} </ref><ref name="pmid30175599">{{cite journal| author=Lewis TC, Aberle C, Altshuler D, Piper GL, Papadopoulos J| title=Comparative Effectiveness and Safety Between Milrinone or Dobutamine as Initial Inotrope Therapy in Cardiogenic Shock. | journal=J Cardiovasc Pharmacol Ther | year= 2019 | volume= 24 | issue= 2 | pages= 130-138 | pmid=30175599 | doi=10.1177/1074248418797357 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30175599  }} </ref><ref name="pmid29976291">{{cite journal| author=Levy B, Clere-Jehl R, Legras A, Morichau-Beauchant T, Leone M, Frederique G | display-authors=etal| title=Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction. | journal=J Am Coll Cardiol | year= 2018 | volume= 72 | issue= 2 | pages= 173-182 | pmid=29976291 | doi=10.1016/j.jacc.2018.04.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29976291  }} </ref><ref name="pmid21037469">{{cite journal| author=Levy B, Perez P, Perny J, Thivilier C, Gerard A| title=Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study. | journal=Crit Care Med | year= 2011 | volume= 39 | issue= 3 | pages= 450-5 | pmid=21037469 | doi=10.1097/CCM.0b013e3181ffe0eb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21037469  }} </ref>23977106<ref name="pmid30228252">{{cite journal| author=Schumann J| title=Cochrane corner: inotropic agents and vasodilator strategies for cardiogenic shock or low cardiac output syndrome. | journal=Heart | year= 2019 | volume= 105 | issue= 3 | pages= 178-179 | pmid=30228252 | doi=10.1136/heartjnl-2018-313854 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30228252  }} </ref><ref name="pmid26475799">{{cite journal| author=Belletti A, Castro ML, Silvetti S, Greco T, Biondi-Zoccai G, Pasin L | display-authors=etal| title=The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. | journal=Br J Anaesth | year= 2015 | volume= 115 | issue= 5 | pages= 656-75 | pmid=26475799 | doi=10.1093/bja/aev284 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26475799  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
:'''e.''' who may need consideration for advanced device therapy or [[Congestive heart failure cardiac transplantation|transplantation]].
|}


'''4.''' [[Congestive heart failure ultrafiltration|Ultrafiltration]] is reasonable for patients with refractory congestion not responding to medical therapy. (248) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[cardiogenic shock]], temporary MCS is reasonable when end-organ function cannot be maintained by [[pharmacologic]] means to support [[cardiac]] function. <ref name="pmid25277608">{{cite journal| author=Stretch R, Sauer CM, Yuh DD, Bonde P| title=National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 14 | pages= 1407-15 | pmid=25277608 | doi=10.1016/j.jacc.2014.07.958 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25277608  }} </ref><ref name="pmid23212552">{{cite journal| author=Lauten A, Engström AE, Jung C, Empen K, Erne P, Cook S | display-authors=etal| title=Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 1 | pages= 23-30 | pmid=23212552 | doi=10.1161/CIRCHEARTFAILURE.112.967224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23212552  }} </ref><ref name="pmid28882288">{{cite journal| author=Flaherty MP, Khan AR, O'Neill WW| title=Early Initiation of Impella in Acute Myocardial Infarction Complicated by Cardiogenic Shock Improves Survival: A Meta-Analysis. | journal=JACC Cardiovasc Interv | year= 2017 | volume= 10 | issue= 17 | pages= 1805-1806 | pmid=28882288 | doi=10.1016/j.jcin.2017.06.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28882288  }} </ref><ref name="pmid28040188">{{cite journal| author=Basir MB, Schreiber TL, Grines CL, Dixon SR, Moses JW, Maini BS | display-authors=etal| title=Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock. | journal=Am J Cardiol | year= 2017 | volume= 119 | issue= 6 | pages= 845-851 | pmid=28040188 | doi=10.1016/j.amjcard.2016.11.037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28040188  }} </ref><ref name="pmid23260710">{{cite journal| author=Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM | display-authors=etal| title=Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. | journal=J Heart Lung Transplant | year= 2013 | volume= 32 | issue= 1 | pages= 106-11 | pmid=23260710 | doi=10.1016/j.healun.2012.10.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23260710  }} </ref><ref name="pmid30586755">{{cite journal| author=Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F | display-authors=etal| title=Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock. | journal=Circulation | year= 2019 | volume= 139 | issue= 10 | pages= 1249-1258 | pmid=30586755 | doi=10.1161/CIRCULATIONAHA.118.036614 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30586755  }} </ref><ref name="pmid25543217">{{cite journal| author=Xie A, Phan K, Tsai YC, Yan TD, Forrest P| title=Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. | journal=J Cardiothorac Vasc Anesth | year= 2015 | volume= 29 | issue= 3 | pages= 637-45 | pmid=25543217 | doi=10.1053/j.jvca.2014.09.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25543217  }} </ref><ref name="pmid28471885">{{cite journal| author=Dangers L, Bréchot N, Schmidt M, Lebreton G, Hékimian G, Nieszkowska A | display-authors=etal| title=Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure. | journal=Crit Care Med | year= 2017 | volume= 45 | issue= 8 | pages= 1359-1366 | pmid=28471885 | doi=10.1097/CCM.0000000000002485 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28471885  }} </ref><ref name="pmid: 29266676">{{cite journal| author=Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S | display-authors=etal| title=Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative. | journal=Catheter Cardiovasc Interv | year= 2018 | volume= 91 | issue= 3 | pages= 454-461 | pmid=: 29266676 | doi=10.1002/ccd.27427 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29266676  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
|-
'''1.''' Intravenous [[Congestive heart failure positive inotropics|inotropic drugs]] such as [[dopamine]], [[dobutamine]] or [[milrinone]] might be reasonable for those patients presenting with documented severe [[systolic dysfunction]], [[hypotension|low blood pressure]] and evidence of low [[cardiac output]], with or without congestion, to maintain systemic perfusion and preserve end-organ performance. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In [[patients]] with [[cardiogenic shock]], management by a multidisciplinary team experienced in [[shock]] is reasonable. <ref name="pmid: 29266676">{{cite journal| author=Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S | display-authors=etal| title=Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative. | journal=Catheter Cardiovasc Interv | year= 2018 | volume= 91 | issue= 3 | pages= 454-461 | pmid=: 29266676 | doi=10.1002/ccd.27427 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29266676  }} </ref><ref name="pmid31025538">{{cite journal| author=Basir MB, Kapur NK, Patel K, Salam MA, Schreiber T, Kaki A | display-authors=etal| title=Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative. | journal=Catheter Cardiovasc Interv | year= 2019 | volume= 93 | issue= 7 | pages= 1173-1183 | pmid=31025538 | doi=10.1002/ccd.28307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31025538  }} </ref><ref name="pmid31549877">{{cite journal| author=Taleb I, Koliopoulou AG, Tandar A, McKellar SH, Tonna JE, Nativi-Nicolau J | display-authors=etal| title=Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Proof of Concept. | journal=Circulation | year= 2019 | volume= 140 | issue= 1 | pages= 98-100 | pmid=31549877 | doi=10.1161/CIRCULATIONAHA.119.040654 | pmc=6872455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31549877  }} </ref><ref name="pmid30947919">{{cite journal| author=Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC | display-authors=etal| title=Standardized Team-Based Care for Cardiogenic Shock. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 13 | pages= 1659-1669 | pmid=30947919 | doi=10.1016/j.jacc.2018.12.084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30947919  }} </ref><ref name="pmid32695976">{{cite journal| author=Lee F, Hutson JH, Boodhwani M, McDonald B, So D, De Roock S | display-authors=etal| title=Multidisciplinary Code Shock Team in Cardiogenic Shock: A Canadian Centre Experience. | journal=CJC Open | year= 2020 | volume= 2 | issue= 4 | pages= 249-257 | pmid=32695976 | doi=10.1016/j.cjco.2020.03.009 | pmc=7365831 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32695976  }} </ref><ref name="pmid25559014">{{cite journal| author=Shaefi S, O'Gara B, Kociol RD, Joynt K, Mueller A, Nizamuddin J | display-authors=etal| title=Effect of cardiogenic shock hospital volume on mortality in patients with cardiogenic shock. | journal=J Am Heart Assoc | year= 2015 | volume= 4 | issue= 1 | pages= e001462 | pmid=25559014 | doi=10.1161/JAHA.114.001462 | pmc=4330069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25559014  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
|}


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
{|class="wikitable" style="width:80%"
'''1.''' Use of parenteral [[Congestive heart failure positive inotropics|inotropes]] in normotensive patients with acute [[decompensated HF]] without evidence of decreased organ perfusion is not recommended. (249) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
|-
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In [[patients]] presenting with [[cardiogenic shock]], placement of a PA line may be considered to define [[hemodynamic]] subsets and appropriate [[management]] strategies.<ref name="pmid33121702">{{cite journal| author=Garan AR, Kanwar M, Thayer KL, Whitehead E, Zweck E, Hernandez-Montfort J | display-authors=etal| title=Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality. | journal=JACC Heart Fail | year= 2020 | volume= 8 | issue= 11 | pages= 903-913 | pmid=33121702 | doi=10.1016/j.jchf.2020.08.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33121702  }} </ref><ref name="pmid32239806">{{cite journal| author=Vallabhajosyula S, Shankar A, Patlolla SH, Prasad A, Bell MR, Jentzer JC | display-authors=etal| title=Pulmonary artery catheter use in acute myocardial infarction-cardiogenic shock. | journal=ESC Heart Fail | year= 2020 | volume= 7 | issue= 3 | pages= 1234-1245 | pmid=32239806 | doi=10.1002/ehf2.12652 | pmc=7261549 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32239806  }} </ref><ref name="pmid30858119">{{cite journal| author=Hernandez GA, Lemor A, Blumer V, Rueda CA, Zalawadiya S, Stevenson LW | display-authors=etal| title=Trends in Utilization and Outcomes of Pulmonary Artery Catheterization in Heart Failure With and Without Cardiogenic Shock. | journal=J Card Fail | year= 2019 | volume= 25 | issue= 5 | pages= 364-371 | pmid=30858119 | doi=10.1016/j.cardfail.2019.03.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30858119  }} </ref><ref name="pmid30297267">{{cite journal| author=Nalluri N, Patel NJ, Atti V, Kumar V, Basir MB, O'Neill WW| title=Temporal Trends in Utilization of Right-Sided Heart Catheterization Among Percutaneous Ventricular Assist Device Recipients in Acute Myocardial Infarction Complicated by Cardiogenic Shock. | journal=Am J Cardiol | year= 2018 | volume= 122 | issue= 12 | pages= 2014-2017 | pmid=30297267 | doi=10.1016/j.amjcard.2018.08.065 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30297267  }} </ref><ref name="pmid27553044">{{cite journal| author=Rossello X, Vila M, Rivas-Lasarte M, Ferrero-Gregori A, Sans-Roselló J, Duran-Cambra A | display-authors=etal| title=Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock. | journal=Cardiology | year= 2017 | volume= 136 | issue= 1 | pages= 61-69 | pmid=27553044 | doi=10.1159/000448110 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27553044  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


'''2.''' Routine use of [[Congestive heart failure invasive monitoring|invasive hemodynamic monitoring]] in normotensive patients with acute [[decompensated HF]] and congestion with symptomatic response to [[Congestive heart failure diuretics|diuretics]] and [[Congestive heart failure vasodilators|vasodilators]] is not recommended. (250) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' For [[patients]] who are not rapidly responding to initial [[shock]] measures, [[triage]] to centers that can provide temporary MCS may be considered to optimize [[management]]. <ref name="pmid: 29266676">{{cite journal| author=Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S | display-authors=etal| title=Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative. | journal=Catheter Cardiovasc Interv | year= 2018 | volume= 91 | issue= 3 | pages= 454-461 | pmid=: 29266676 | doi=10.1002/ccd.27427 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29266676  }} </ref><ref name="pmid31025538">{{cite journal| author=Basir MB, Kapur NK, Patel K, Salam MA, Schreiber T, Kaki A | display-authors=etal| title=Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative. | journal=Catheter Cardiovasc Interv | year= 2019 | volume= 93 | issue= 7 | pages= 1173-1183 | pmid=31025538 | doi=10.1002/ccd.28307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31025538  }} </ref><ref name="pmid31549877">{{cite journal| author=Taleb I, Koliopoulou AG, Tandar A, McKellar SH, Tonna JE, Nativi-Nicolau J | display-authors=etal| title=Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Proof of Concept. | journal=Circulation | year= 2019 | volume= 140 | issue= 1 | pages= 98-100 | pmid=31549877 | doi=10.1161/CIRCULATIONAHA.119.040654 | pmc=6872455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31549877  }} </ref><ref name="pmid30947919">{{cite journal| author=Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC | display-authors=etal| title=Standardized Team-Based Care for Cardiogenic Shock. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 13 | pages= 1659-1669 | pmid=30947919 | doi=10.1016/j.jacc.2018.12.084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30947919  }} </ref><ref name="pmid32695976">{{cite journal| author=Lee F, Hutson JH, Boodhwani M, McDonald B, So D, De Roock S | display-authors=etal| title=Multidisciplinary Code Shock Team in Cardiogenic Shock: A Canadian Centre Experience. | journal=CJC Open | year= 2020 | volume= 2 | issue= 4 | pages= 249-257 | pmid=32695976 | doi=10.1016/j.cjco.2020.03.009 | pmc=7365831 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32695976  }} </ref><ref name="pmid25559014">{{cite journal| author=Shaefi S, O'Gara B, Kociol RD, Joynt K, Mueller A, Nizamuddin J | display-authors=etal| title=Effect of cardiogenic shock hospital volume on mortality in patients with cardiogenic shock. | journal=J Am Heart Assoc | year= 2015 | volume= 4 | issue= 1 | pages= e001462 | pmid=25559014 | doi=10.1161/JAHA.114.001462 | pmc=4330069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25559014  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
|}


==Vote on and Suggest Revisions to the Current Guidelines==
===Integration of [[Care]]: Transitions and Team-Based Approaches (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
 
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with high-risk [[HF]], particularly those with recurrent [[hospitalizations]] for [[HFrEF]], referral to multidisciplinary [[HF]] [[disease]] [[management]] programs is recommended to reduce the risk of [[hospitalization]]. <ref name="pmid24862840">{{cite journal| author=Feltner C, Jones CD, Cené CW, Zheng ZJ, Sueta CA, Coker-Schwimmer EJ | display-authors=etal| title=Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. | journal=Ann Intern Med | year= 2014 | volume= 160 | issue= 11 | pages= 774-84 | pmid=24862840 | doi=10.7326/M14-0083 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24862840  }} </ref><ref name="pmid31978280">{{cite journal| author=Kalogirou F, Forsyth F, Kyriakou M, Mantle R, Deaton C| title=Heart failure disease management: a systematic review of effectiveness in heart failure with preserved ejection fraction. | journal=ESC Heart Fail | year= 2020 | volume= 7 | issue= 1 | pages= 194-212 | pmid=31978280 | doi=10.1002/ehf2.12559 | pmc=7083420 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31978280  }} </ref><ref name="pmid30620776">{{cite journal| author=Takeda A, Martin N, Taylor RS, Taylor SJ| title=Disease management interventions for heart failure. | journal=Cochrane Database Syst Rev | year= 2019 | volume= 1 | issue=  | pages= CD002752 | pmid=30620776 | doi=10.1002/14651858.CD002752.pub4 | pmc=6492456 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30620776  }} </ref><ref name="pmid28233442">{{cite journal| author=Van Spall HGC, Rahman T, Mytton O, Ramasundarahettige C, Ibrahim Q, Kabali C | display-authors=etal| title=Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. | journal=Eur J Heart Fail | year= 2017 | volume= 19 | issue= 11 | pages= 1427-1443 | pmid=28233442 | doi=10.1002/ejhf.765 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28233442  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In [[patients]] [[hospitalized]] with worsening [[HF]], [[patient]]-centered discharge instructions with a clear plan for transitional [[care]] should be provided before [[hospital]] discharge. <ref name="pmid15642765">{{cite journal| author=Koelling TM, Johnson ML, Cody RJ, Aaronson KD| title=Discharge education improves clinical outcomes in patients with chronic heart failure. | journal=Circulation | year= 2005 | volume= 111 | issue= 2 | pages= 179-85 | pmid=15642765 | doi=10.1161/01.CIR.0000151811.53450.B8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15642765  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
 
|}
 
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In [[patients]] [[hospitalized]] with worsening [[HF]], participation in systems that allow benchmarking to performance measures is reasonable to increase use of evidence-based [[therapy]], and to improve quality of [[care]]. <ref name="pmid27729027">{{cite journal| author=Driscoll A, Meagher S, Kennedy R, Hay M, Banerji J, Campbell D | display-authors=etal| title=What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review. | journal=BMC Cardiovasc Disord | year= 2016 | volume= 16 | issue= 1 | pages= 195 | pmid=27729027 | doi=10.1186/s12872-016-0371-7 | pmc=5057466 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27729027  }} </ref><ref name="pmid17646603">{{cite journal| author=Fonarow GC, Abraham WT, Albert NM, Gattis Stough W, Gheorghiade M, Greenberg BH | display-authors=etal| title=Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). | journal=Arch Intern Med | year= 2007 | volume= 167 | issue= 14 | pages= 1493-502 | pmid=17646603 | doi=10.1001/archinte.167.14.1493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17646603  }} </ref><ref name="pmid15381518">{{cite journal| author=Lappé JM, Muhlestein JB, Lappé DL, Badger RS, Bair TL, Brockman R | display-authors=etal| title=Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program. | journal=Ann Intern Med | year= 2004 | volume= 141 | issue= 6 | pages= 446-53 | pmid=15381518 | doi=10.7326/0003-4819-141-6-200409210-00010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15381518  }} </ref><ref name="pmid18823852">{{cite journal| author=Heidenreich P| title=Improving heart failure care with a reminder attached to the echocardiography report. | journal=Am J Med | year= 2008 | volume= 121 | issue= 10 | pages= 853-4 | pmid=18823852 | doi=10.1016/j.amjmed.2008.06.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18823852  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
 
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In [[patients]] being discharged after [[hospitalization]] for worsening [[HF]], an early follow up, generally within 7 days of [[hospital]] discharge is reasonable to optimize [[care]] and reduce rehospitalization. <ref name="pmid20442387">{{cite journal| author=Hernandez AF, Greiner MA, Fonarow GC, Hammill BG, Heidenreich PA, Yancy CW | display-authors=etal| title=Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. | journal=JAMA | year= 2010 | volume= 303 | issue= 17 | pages= 1716-22 | pmid=20442387 | doi=10.1001/jama.2010.533 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20442387  }} </ref><ref name="pmid26978568">{{cite journal| author=Lee KK, Yang J, Hernandez AF, Steimle AE, Go AS| title=Post-discharge Follow-up Characteristics Associated With 30-Day Readmission After Heart Failure Hospitalization. | journal=Med Care | year= 2016 | volume= 54 | issue= 4 | pages= 365-72 | pmid=26978568 | doi=10.1097/MLR.0000000000000492 | pmc=4800825 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26978568  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
 
|}
 
==External Links==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>
 
*[http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8807.full.pdf 2013 ACCF/AHA Guideline for the Management of Heart Failure]<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 |volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref>


==Guidelines Resources==
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>


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==References==
==References==
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Latest revision as of 10:42, 21 June 2022
Resident
Survival
Guide
File:Critical Pathways.gif

Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure AHA recommendations for hospitalized patient On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure AHA recommendations for hospitalized patient

CDC on Congestive heart failure AHA recommendations for hospitalized patient

Congestive heart failure AHA recommendations for hospitalized patient in the news

Blogs on Congestive heart failure AHA recommendations for hospitalized patient

Directions to Hospitals Treating Congestive heart failure AHA recommendations for hospitalized patient

Risk calculators and risk factors for Congestive heart failure AHA recommendations for hospitalized patient

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2] Edzel Lorraine Co, D.M.D., M.D. [3]

2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2][3]

PATIENTS HOSPITALIZED WITH ACUTE DECOMPENSATED HF 2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2][3]

Assessment of Patients Hospitalized With Decompensated HF (DO NOT EDIT) [1][2][3]

Class I
"1. In patients hospitalized with HF, severity of congestion and adequacy of perfusion should be assessed to guide triage and initial therapy. [4] [5][6][7][8] (Level of Evidence: B-NR) "
"2. In patients hospitalized with HF, the common precipitating factors and the overall patient trajectory should be assessed to guide appropriate therapy. [8][9] (Level of Evidence: B-NR) "
"3. For patients admitted with HF, treatment should address reversible factors, establish optimal volume status, and advance GDMT toward targets for outpatient therapy.[9] (Level of Evidence: B-NR) "

Maintenance or Optimization of GDMT During Hospitalization (DO NOT EDIT) [1][2][3]

Class I
"1. In patients with HFrEF requiring hospitalization, preexisting GDMT should be continued and optimized to improve outcomes, unless contraindicated. [10][11][12][13][14] (Level of Evidence: B-NR) "
"2. In patients experiencing mild decrease of renal function or asymptomatic reduction of blood pressure during HF hospitalization, diuresis and other GDMT should not routinely be discontinued. [15][16][17][18][19][20](Level of Evidence: B-NR) "
"3.In patients with HFrEF, GDMT should be initiated during hospitalization after clinical stability is achieved.[11][12][14][21][22][23][24][25][26][27] (Level of Evidence: B-NR) "
"4.In patients with HFrEF, if discontinuation of GDMT is necessary during hospitalization, it should be reinitiated and further optimized as soon as possible. [28][29][30][31] (Level of Evidence: B-NR) "

Diuretics in Hospitalized Patients: Decongestion Strategy (DO NOT EDIT) [1][2][3]

Class I
"1. Patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to improve symptoms and reduce morbidity. Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute

decompensated heart failure. N Engl J Med. 2011;364:797–805. (Level of Evidence: B-NR) "

"2. For patients hospitalized with HF, therapy with diuretics and other guideline-directed medications should be titrated with a goal to resolve clinical evidence of congestion to reduce symptoms and rehospitalizations. [31][32][33][34][7][5](Level of Evidence: B-NR) "
"3.For patients requiring diuretic treatment during hospitalization for HF, the discharge regimen should include a plan for adjustment of diuretics to decrease rehospitalizations.[35] (Level of Evidence: B-NR) "
"4.In patients with HF when diuresis is inadequate to relieve symptoms and signs of congestion, it is reasonable to intensify the diuretic regimen using either: a. higher doses of intravenous loop diuretics [36][33]); or b. addition of a second diuretic. [33] (Level of Evidence: B-NR) "

Parenteral Vasodilation Therapy in Patients Hospitalized With HF (DO NOT EDIT) [1][2][3]

Class IIb
"1. In patients who are admitted with decompensated HF, in the absence of systemic hypotension, intravenous nitroglycerin or nitroprusside may be considered as an adjuvant to diuretic therapy for relief of dyspnea. [37][38] (Level of Evidence: B-NR) "

VTE Prophylaxis in Hospitalized Patients (DO NOT EDIT) [1][2][3]

Class I
"1. In patients hospitalized with HF, prophylaxis for VTE is recommended to prevent venous thromboembolic disease. [39][40][41] (Level of Evidence: B-R) "

Evaluation and Management of Cardiogenic Shock (DO NOT EDIT) [1][2][3]

Class I
"1. In patients with cardiogenic shock, intravenous inotropic support should be used to maintain systemic perfusion and preserve end-organ performance.[42][43][44][45][46]23977106[47][48] (Level of Evidence: B-NR) "
Class IIa
"2. In patients with cardiogenic shock, temporary MCS is reasonable when end-organ function cannot be maintained by pharmacologic means to support cardiac function. [49][50][51][52][53][54][55][56][57] (Level of Evidence: B-NR) "
"3. In patients with cardiogenic shock, management by a multidisciplinary team experienced in shock is reasonable. [57][58][59][60][61][62] (Level of Evidence: B-NR) "
Class IIb
"4. In patients presenting with cardiogenic shock, placement of a PA line may be considered to define hemodynamic subsets and appropriate management strategies.[63][64][65][66][67] (Level of Evidence: B-NR) "
"5. For patients who are not rapidly responding to initial shock measures, triage to centers that can provide temporary MCS may be considered to optimize management. [57][58][59][60][61][62] (Level of Evidence: C-LD) "

Integration of Care: Transitions and Team-Based Approaches (DO NOT EDIT) [1][2][3]

Class I
"1. In patients with high-risk HF, particularly those with recurrent hospitalizations for HFrEF, referral to multidisciplinary HF disease management programs is recommended to reduce the risk of hospitalization. [68][69][70][71] (Level of Evidence: B-R) "
"2. In patients hospitalized with worsening HF, patient-centered discharge instructions with a clear plan for transitional care should be provided before hospital discharge. [72](Level of Evidence: B-NR) "
Class IIa
"3. In patients hospitalized with worsening HF, participation in systems that allow benchmarking to performance measures is reasonable to increase use of evidence-based therapy, and to improve quality of care. [73][74][75][76](Level of Evidence: B-NR) "
"4. In patients being discharged after hospitalization for worsening HF, an early follow up, generally within 7 days of hospital discharge is reasonable to optimize care and reduce rehospitalization. [77][78](Level of Evidence: B-NR) "

External Links

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  4. ↑ Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD; et al. (2008). "Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial". Circ Heart Fail. 1 (3): 170–7. doi:10.1161/CIRCHEARTFAILURE.108.769778. PMC 2724723. PMID 19675681.
  5. ↑ 5.0 5.1 Chioncel O, Mebazaa A, Maggioni AP, Harjola VP, Rosano G, Laroche C; et al. (2019). "Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry". Eur J Heart Fail. 21 (11): 1338–1352. doi:10.1002/ejhf.1492. PMID 31127678.
  6. ↑ Cleland JG, Chiswell K, Teerlink JR, Stevens S, Fiuzat M, Givertz MM; et al. (2014). "Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study". Circ Heart Fail. 7 (1): 76–87. doi:10.1161/CIRCHEARTFAILURE.113.000284. PMID 24281134.
  7. ↑ 7.0 7.1 Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B; et al. (2013). "Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial". Eur Heart J. 34 (11): 835–43. doi:10.1093/eurheartj/ehs444. PMID 23293303.
  8. ↑ 8.0 8.1 Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J; et al. (2019). "2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee". J Am Coll Cardiol. 74 (15): 1966–2011. doi:10.1016/j.jacc.2019.08.001. PMID 31526538.
  9. ↑ 9.0 9.1 Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF; et al. (2016). "Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction". JACC Heart Fail. 4 (6): 464–72. doi:10.1016/j.jchf.2016.02.017. PMID 27256749.
  10. ↑ Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH; et al. (2008). "Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program". J Am Coll Cardiol. 52 (3): 190–9. doi:10.1016/j.jacc.2008.03.048. PMID 18617067.
  11. ↑ 11.0 11.1 Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD; et al. (2017). "Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction". J Am Heart Assoc. 6 (2). doi:10.1161/JAHA.116.004675. PMC 5523765. PMID 28189999.
  12. ↑ 12.0 12.1 Maisel A, Xue Y, van Veldhuisen DJ, Voors AA, Jaarsma T, Pang PS; et al. (2014). "Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study)". Am J Cardiol. 114 (5): 737–42. doi:10.1016/j.amjcard.2014.05.062. PMID 25129066.
  13. ↑ Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S (2015). "Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis". JACC Heart Fail. 3 (8): 647–53. doi:10.1016/j.jchf.2015.03.008. PMC 4777602. PMID 26251094.
  14. ↑ 14.0 14.1 Tran RH, Aldemerdash A, Chang P, Sueta CA, Kaufman B, Asafu-Adjei J; et al. (2018). "Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure". Pharmacotherapy. 38 (4): 406–416. doi:10.1002/phar.2091. PMC 5902433. PMID 29423950.
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  17. ↑ Montero-Perez-Barquero M, Flather M, Roughton M, Coats A, Böhm M, Van Veldhuisen DJ; et al. (2014). "Influence of systolic blood pressure on clinical outcomes in elderly heart failure patients treated with nebivolol: data from the SENIORS trial". Eur J Heart Fail. 16 (9): 1009–15. doi:10.1002/ejhf.136. PMID 25044535.
  18. ↑ Anand IS, Rector TS, Kuskowski M, Thomas S, Holwerda NJ, Cohn JN (2008). "Effect of baseline and changes in systolic blood pressure over time on the effectiveness of valsartan in the Valsartan Heart Failure Trial". Circ Heart Fail. 1 (1): 34–42. doi:10.1161/CIRCHEARTFAILURE.107.736975. PMID 19808268.
  19. ↑ Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco-Bacik MA, Chen HH; et al. (2018). "Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury". Circulation. 137 (19): 2016–2028. doi:10.1161/CIRCULATIONAHA.117.030112. PMC 6066176. PMID 29352071.
  20. ↑ Brunner-La Rocca HP, Knackstedt C, Eurlings L, Rolny V, Krause F, Pfisterer ME; et al. (2015). "Impact of worsening renal function related to medication in heart failure". Eur J Heart Fail. 17 (2): 159–68. doi:10.1002/ejhf.210. PMID 25808849.
  21. ↑ Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH; et al. (2007). "Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: an analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)". Am Heart J. 153 (1): 82.e1–11. doi:10.1016/j.ahj.2006.10.008. PMID 17174643.
  22. ↑ Hernandez AF, Hammill BG, O'Connor CM, Schulman KA, Curtis LH, Fonarow GC (2009). "Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry". J Am Coll Cardiol. 53 (2): 184–92. doi:10.1016/j.jacc.2008.09.031. PMC 3513266. PMID 19130987.
  23. ↑ Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD; et al. (2015). "Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure". Am J Med. 128 (7): 715–21. doi:10.1016/j.amjmed.2014.11.036. PMC 6756434 Check |pmc= value (help). PMID 25554369.
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  27. ↑ Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K; et al. (2019). "Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure". N Engl J Med. 380 (6): 539–548. doi:10.1056/NEJMoa1812851. PMID 30415601.
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  36. ↑ Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR; et al. (2011). "Diuretic strategies in patients with acute decompensated heart failure". N Engl J Med. 364 (9): 797–805. doi:10.1056/NEJMoa1005419. PMC 3412356. PMID 21366472. Review in: Ann Intern Med. 2011 Jul 19;155(2):JC1-5
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  50. ↑ Lauten A, Engström AE, Jung C, Empen K, Erne P, Cook S; et al. (2013). "Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry". Circ Heart Fail. 6 (1): 23–30. doi:10.1161/CIRCHEARTFAILURE.112.967224. PMID 23212552.
  51. ↑ Flaherty MP, Khan AR, O'Neill WW (2017). "Early Initiation of Impella in Acute Myocardial Infarction Complicated by Cardiogenic Shock Improves Survival: A Meta-Analysis". JACC Cardiovasc Interv. 10 (17): 1805–1806. doi:10.1016/j.jcin.2017.06.027. PMID 28882288.
  52. ↑ Basir MB, Schreiber TL, Grines CL, Dixon SR, Moses JW, Maini BS; et al. (2017). "Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock". Am J Cardiol. 119 (6): 845–851. doi:10.1016/j.amjcard.2016.11.037. PMID 28040188.
  53. ↑ Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM; et al. (2013). "Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era". J Heart Lung Transplant. 32 (1): 106–11. doi:10.1016/j.healun.2012.10.005. PMID 23260710.
  54. ↑ Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F; et al. (2019). "Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock". Circulation. 139 (10): 1249–1258. doi:10.1161/CIRCULATIONAHA.118.036614. PMID 30586755.
  55. ↑ Xie A, Phan K, Tsai YC, Yan TD, Forrest P (2015). "Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis". J Cardiothorac Vasc Anesth. 29 (3): 637–45. doi:10.1053/j.jvca.2014.09.005. PMID 25543217.
  56. ↑ Dangers L, Bréchot N, Schmidt M, Lebreton G, Hékimian G, Nieszkowska A; et al. (2017). "Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure". Crit Care Med. 45 (8): 1359–1366. doi:10.1097/CCM.0000000000002485. PMID 28471885.
  57. ↑ 57.0 57.1 57.2 Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S; et al. (2018). "Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative". Catheter Cardiovasc Interv. 91 (3): 454–461. doi:10.1002/ccd.27427. PMID 29266676 : 29266676 Check |pmid= value (help).
  58. ↑ 58.0 58.1 Basir MB, Kapur NK, Patel K, Salam MA, Schreiber T, Kaki A; et al. (2019). "Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative". Catheter Cardiovasc Interv. 93 (7): 1173–1183. doi:10.1002/ccd.28307. PMID 31025538.
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  60. ↑ 60.0 60.1 Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC; et al. (2019). "Standardized Team-Based Care for Cardiogenic Shock". J Am Coll Cardiol. 73 (13): 1659–1669. doi:10.1016/j.jacc.2018.12.084. PMID 30947919.
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  80. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112 (12):e154-235. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202

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