Acute heart failure - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute heart failure is a clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressure, and tissue congestion.
Presents with dyspnea, decreased exercise tolerance, swelling of the legs, fatigue, and generalized weakness.
Clinical diagnosis is supported by ancillary tests such as ECG, chest x-ray, B-type natriuretic peptide, and echocardiogram. In cases where echocardiographic images are suboptimal or when an unusual cause of heart failure is suspected, and for diagnosis of specific cardiomyopathies, other tests (e.g., cardiac catheterization with hemodynamic measurements, computed tomography, and cardiac magnetic resonance imaging) are used.
Diuretics, oxygen, and vasodilators are initial treatments for symptom relief. Cardiogenic shock may require vasoactive agents, mechanical ventilation, or mechanical circulatory support.
If acute myocardial infarction is present, early revascularization is essential.

Chest x-ray of acute pulmonary edema showing increased alveolar markings, fluid in the horizontal fissure, and blunting of the costophrenic angles

From the private collections of Syed W. Yusuf, MBBS, MRCPI, and Daniel Lenihan, MD; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

ECG showing left ventricular hypertrophy with sinus tachycardia
Chest x-ray of acute pulmonary edema showing increased alveolar markings, fluid in the horizontal fissure, and blunting of the costophrenic angles
Chest x-ray of acute pulmonary edema showing increased alveolar markings and bilateral pleural effusions
Systolic image of dilated left ventricle (arrow); note there is no change from diastolic image
Diastolic image of dilated left ventricle (arrow)

Citations

Key Articles

McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.[Abstract][Full Text]
Heidenreich PA, Bozkurt B, Aguilar D, et al. 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. Circulation. 2022 May 3;145(18):e895-1032.[Abstract][Full Text]
Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Can J Cardiol. 2017 Nov;33(11):1342-433.[Abstract][Full Text]

Other Online Resources

CODE-HF tool

Referenced Articles

1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.[Abstract][Full Text]
2. Heidenreich PA, Bozkurt B, Aguilar D, et al. 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. Circulation. 2022 May 3;145(18):e895-1032.[Abstract][Full Text]
3. Filippatos G, Zannad F. An introduction to acute heart failure syndromes: definition and classification. Heart Fail Rev. 2007 Jun;12(2):87-90.[Abstract]
4. McDermott KW, Roemer M. Most frequent principal diagnoses for inpatient stays in U.S. hospitals, 2018. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2006: Statistical Brief #277.[Full Text]
5. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Feb 20;149(8):e347-e913.[Abstract][Full Text]
6. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017 Apr;3(1):7-11.[Abstract][Full Text]
7. Kimmoun A, Takagi K, Gall E, et al. Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades. Eur J Heart Fail. 2021 Mar;23(3):420-31.[Abstract][Full Text]
8. Gheorghiade M, Zannad F, Sopko G, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005 Dec 20;112(25):3958-68.[Abstract][Full Text]
9. Jackson G, Gibbs CR, Davies MK, Lip GY. ABC of heart failure. Pathophysiology. BMJ. 2000 Jan 15;320(7228):167-70.[Abstract]
10. Fonarow GC. The Acute Decompensated Heart Failure National Registry (ADHERE): opportunities to improve care of patients hospitalized with acute decompensated heart failure. Rev Cardiovasc Med. 2003;4(suppl 7):S21-30.[Abstract]
11. Fonarow GC, Abraham WT, Albert NM, et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007 Jan 3;297(1):61-70.[Abstract][Full Text]
12. Abraham WT, Adams KF, Fonarow GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005 Jul 5;46(1):57-64.[Abstract]
13. Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006 Nov;27(22):2725-36.[Abstract][Full Text]
14. Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Atrial fibrillation in acute heart failure: a position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care. 2020 Jun;9(4):348-57.[Abstract][Full Text]
15. Mundisugih J, Franke KB, Tully PJ, et al. Prevalence and prognostic implication of atrial fibrillation in heart failure subtypes: systematic review and meta-analysis. Heart Lung Circ. 2023 Jun;32(6):666-77.[Abstract]
16. Tsuyuki RT, McKelvie RS, Arnold JM, et al. Acute precipitants of congestive heart failure exacerbations. Arch Intern Med. 2001 2001 Oct 22;161(19):2337-42.[Abstract][Full Text]
17. Takizawa M, Kobayakawa N, Uozumi H, et al. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int J Cardiol. 2007 Jan 2;114(1):e15-7.[Abstract]
18. Manja V, Nrusimha A, Gao Y, et al. Methamphetamine-associated heart failure: a systematic review of observational studies. Heart. 2023 Jan 11;109(3):168-77.[Abstract]
19. Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2006 Mar;8(3):217-8.[Abstract][Full Text]
20. Berlin T, Lubina A, Levy Y, et al. Graves' disease presenting as right heart failure. Isr Med Assoc J. 2006 Mar;8(3):217-8.[Abstract]
21. Klatsky AL, Chartier D, Udaltsova N, et al. Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease. Am J Cardiol. 2005 Aug 1;96(3):346-51.[Abstract]
22. Biddinger KJ, Emdin CA, Haas ME, et al. Association of habitual alcohol intake with risk of cardiovascular disease. JAMA Netw Open. 2022 Mar 1;5(3):e223849.[Abstract][Full Text]
23. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 May 25;143(21):e984-1010.[Abstract][Full Text]
24. Pandey A, Patel KV, Vaduganathan M, et al. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail. 2018 Dec;6(12):975-82.[Abstract][Full Text]
25. Pandey A, LaMonte M, Klein L, et al. Relationship between physical activity, body mass index, and risk of heart failure. J Am Coll Cardiol. 2017 Mar 7;69(9):1129-42.[Abstract][Full Text]
26. Konstam MA, Kronenberg MW, Rousseau MF, et al. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. Circulation. 1993 Nov;88(5 Pt 1):2277-83.[Abstract][Full Text]
27. Yusuf S, Sleight P, Pogue J, et al; the Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000 Jan 20;342(3):145-53.[Abstract][Full Text]
28. Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019 Jan 5;393(10166):31-9.[Abstract]
29. Musso G, Saba F, Cassader M, et al. Diabetic ketoacidosis with SGLT2 inhibitors. BMJ. 2020 Nov 12;371:m4147.[Abstract]
30. Page RL, O'Bryant CL, Cheng D, et al. Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association. Circulation. 2016 Aug 9;134(6):e32-69.[Abstract][Full Text]
31. Heart Failure Society of America. Executive summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010 Jun;16(6):e1-194.[Abstract]
32. Gillespie ND, McNeill G, Pringle T, et al. Cross sectional study of contribution of clinical assessment and simple cardiac investigations to diagnosis of left ventricular systolic dysfunction in patients admitted with acute dyspnoea. BMJ. 1997 Mar 29;314(7085):936-40.[Abstract][Full Text]
33. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes. Jun 2022 [internet publication].[Full Text]
34. Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al. Appropriate use of point-of-care ultrasonography in patients with acute dyspnea in emergency department or inpatient settings: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021 Jul;174(7):985-93.[Abstract][Full Text]
35. Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Can J Cardiol. 2017 Nov;33(11):1342-433.[Abstract][Full Text]
36. Renier W, Winckelmann KH, Verbakel JY, et al. Signs and symptoms in adult patients with acute dyspnea: a systematic review and meta-analysis. Eur J Emerg Med. 2018 Feb;25(1):3-11.[Abstract]
37. Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA. 2002 Feb 6;287(5):628-40.[Abstract][Full Text]
38. Khan NK, Goode KM, Cleland JG, et al. Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge. Eur J Heart Fail. 2007 May;9(5):491-501.[Abstract]
39. Čelutkienė J, Lainscak M, Anderson L, et al. Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020 Feb;22(2):181-95.[Abstract][Full Text]
40. Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002 Jul 18;347(3):161-7.[Abstract][Full Text]
41. Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004 Feb 12;350(7):647-54.[Abstract][Full Text]
42. Morrison LK, Harrison A, Krishnaswamy P, et al. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol. 2002 Jan 16;39(2):202-9.[Abstract]
43. Fonarow GC, Peacock WF, Phillips CO, et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007 May 15;49(19):1943-50.[Abstract]
44. Burke MA, Cotts WG. Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions. Heart Fail Rev. 2007 Mar;12(1):23-36.[Abstract]
45. Lee KK, Doudesis D, Anwar M, et al. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study. BMJ. 2022 Jun 13;377:e068424.[Abstract][Full Text]
46. Perna ER, Macin SM, Parras JI, et al. Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema. Am Heart J. 2002 May;143(5):814-20.[Abstract]
47. Evans JDW, Dobbin SJH, Pettit SJ, et al. High-sensitivity cardiac troponin and new-onset heart failure: a systematic review and meta-analysis of 67,063 patients with 4,165 incident heart failure events. JACC Heart Fail. 2018 Mar;6(3):187-97.[Abstract]
48. El Iskandarani M, El Kurdi B, Murtaza G, et al. Prognostic role of albumin level in heart failure: a systematic review and meta-analysis. Medicine (Baltimore). 2021 Mar 12;100(10):e24785.[Abstract][Full Text]
49. Chow SL, Maisel AS, Anand I, et al. Role of biomarkers for the prevention, assessment, and management of heart failure: a scientific statement from the American Heart Association. Circulation. 2017 May 30;135(22):e1054-91.[Abstract][Full Text]
50. Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007 Apr;204(4):681-96.[Abstract]
51. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003 Mar 20;348(12):1123-33.[Abstract][Full Text]
52. Smith RN, Nolan JP. Central venous catheters. BMJ. 2013 Nov 11;347:f6570.[Abstract][Full Text]
53. Reich DL. Monitoring in anesthesia and perioperative care. Cambridge: Cambridge University Press; 2011.
54. Abbott Northwestern Hospital Internal Medicine Residency. Internal jugular central venous line. 2022 [internet publication].[Full Text]
55. Bishop L, Dougherty L, Bodenham A, et al. Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol. 2007 Aug;29(4):261-78.[Abstract]
56. Practice guidelines for central venous access 2020: an updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020 Jan;132(1):8-43.[Abstract][Full Text]
57. Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth. 2000 Aug;85(2):188-91.[Abstract]
58. Gibson F, Bodenham A. Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth. 2013 Mar;110(3):333-46.[Abstract][Full Text]
59. Schuster M, Nave H, Piepenbrock S, et al. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000 Aug;85(2):192-4.[Abstract]
60. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.[Abstract][Full Text]
61. McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6.[Abstract]
62. National Institute for Health and Care Excellence (UK). Acute heart failure: diagnosis and management. Nov 2021 [internet publication].[Full Text]
63. Lin Y, Chen Y, Yuan J, et al. Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis. Rev Cardiovasc Med. 2021 Sep 24;22(3):865-72.[Abstract][Full Text]
64. Pratama NR, Anastasia ES, Wardhani NP, et al. Clinical outcomes of opioid administration in acute and chronic heart failure: a meta-analysis. Diabetes Metab Syndr. 2022 Oct;16(10):102636.[Abstract][Full Text]
65. McKelvie RS, Benedict CR, Yusuf S. Evidence based cardiology: prevention of congestive heart failure and management of asymptomatic left ventricular dysfunction. BMJ. 1999 May 22;318(7195):1400-2.[Abstract]
66. McDonagh TA, Metra M, Adamo M, et al. 2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-39.[Abstract][Full Text]
67. Hamza M, Sattar Y, Manasrah N, et al. Meta-analysis of efficacy and safety of intravenous iron in patients with iron deficiency and heart failure with reduced ejection fraction. Am J Cardiol. 2023 Sep 1;202:119-30.[Abstract]
68. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council guidelines 2021: adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
69. Colquhoun MC, Handley AJ, Evans TR. ABC of resuscitation. 5th ed. London: BMJ Publishing Group; 2004.
70. Chrimes N, Higgs A, Hagberg CA, et al. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia. 2022 Dec;77(12):1395-415. [Abstract][Full Text]
71. Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805.[Abstract]
72. Trullàs JC, Morales-Rull JL, Casado J, et al. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J. 2023 Feb 1;44(5):411-21.[Abstract]
73. Mullens W, Dauw J, Martens P, et al. Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med. 2022 Sep 29;387(13):1185-95.[Abstract][Full Text]
74. Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007 Feb 13;49(6):675-83.[Abstract][Full Text]
75. Srivastava M, Harrison N, Caetano AFS, et al. Ultrafiltration for acute heart failure. Cochrane Database Syst Rev. 2022 Jan 21;1(1):CD013593.[Abstract][Full Text]
76. Kivikko M, Pollesello P, Tarvasmäki T, et al. Effect of baseline characteristics on mortality in the SURVIVE trial on the effect of levosimendan vs dobutamine in acute heart failure: Sub-analysis of the Finnish patients. Int J Cardiol. 2016 Jul 15;215:26-31.[Abstract][Full Text]
77. Geller BJ, Sinha SS, Kapur NK, et al. Escalating and de-escalating temporary mechanical circulatory support in cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2022 Aug 9;146(6):e50-68.[Abstract][Full Text]
78. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Dec 23;130(25):e344-426.[Abstract][Full Text]
79. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jul 1;82(1):E1-27.[Abstract][Full Text]
80. Reddy YNV, Borlaug BA, Gersh BJ. Management of atrial fibrillation across the spectrum of heart failure with preserved and reduced ejection fraction. Circulation. 2022 Jul 26;146(4):339-57.[Abstract][Full Text]
81. Chung MK, Patton KK, Lau CP, et al. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm. 2023 Sep;20(9):e17-91.[Abstract][Full Text]
82. Khot UN, Novaro GM, Popovic ZB, et al. Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis. N Engl J Med. 2003 May 1;348(18):1756-63.[Abstract][Full Text]
83. Lahm T, McCaslin CA, Wozniak TC, et al. Medical and surgical treatment of acute right ventricular failure. J Am Coll Cardiol. 2010 Oct 26;56(18):1435-46.[Abstract]
84. Cooper LT Jr, Berry GJ, Shabetai R. Idiopathic giant-cell myocarditis - natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med. 1997 Jun 26;336(26):1860-6.[Abstract][Full Text]
85. Peura JL, Colvin-Adams M, Francis GS, et al; American Heart Association. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012 Nov 27;126(22):2648-67.[Abstract][Full Text]
86. Gopinathannair R, Cornwell WK, Dukes JW, et al. Device therapy and arrhythmia management in left ventricular assist device recipients: a scientific statement from the American Heart Association. Circulation. 2019 May 14;139(20):e967-89.[Abstract][Full Text]
87. Cook JL, Colvin M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: ambulatory and community patient care: a scientific statement from the American Heart Association. Circulation. 2017 Jun 20;135(25):e1145-58.[Abstract][Full Text]
88. Birks EJ, Tansley PD, Hardy J, et al. Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med. 2006 Nov 2;355(18):1873-84.[Abstract][Full Text]
89. Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022 Dec 3;400(10367):1938-52.[Abstract]
90. Usman MS, Siddiqi TJ, Anker SD, et al. Effect of SGLT2 inhibitors on cardiovascular outcomes across various patient populations. J Am Coll Cardiol. 2023 Jun 27;81(25):2377-87.[Abstract]
91. Carvalho PEP, Veiga TMA, Simões E Silva AC, et al. Cardiovascular and renal effects of SGLT2 inhibitor initiation in acute heart failure: a meta-analysis of randomized controlled trials. Clin Res Cardiol. 2023 Aug;112(8):1044-55.[Abstract][Full Text]
92. Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol. 2023 May 9;81(18):1835-78.[Abstract][Full Text]
93. Packer M, Butler J, Zannad F, et al. Effect of empagliflozin on worsening heart failure events in patients with heart failure and preserved ejection fraction: EMPEROR-Preserved trial. Circulation. 2021 Oct 19;144(16):1284-94.[Abstract][Full Text]
94. Desai AS, Jhund PS, Claggett BL, et al. Effect of dapagliflozin on cause-specific mortality in patients with heart failure across the spectrum of ejection fraction: a participant-level pooled analysis of DAPA-HF and DELIVER. JAMA Cardiol. 2022 Dec 1;7(12):1227-34.[Abstract][Full Text]
95. Xiang B, Zhang R, Wu X, et al. Optimal pharmacologic treatment of heart failure with preserved and mildly reduced ejection fraction: a meta-analysis. JAMA Netw Open. 2022 Sep 1;5(9):e2231963.[Abstract][Full Text]
96. Borer JS, Böhm M, Ford I, et al; SHIFT Investigators. Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: the SHIFT Study. Eur Heart J. 2012 Nov;33(22):2813-20.[Abstract][Full Text]
97. Fox K, Ford I, Steg PG, et al. Ivabradine in stable coronary artery disease without clinical heart failure. N Engl J Med. 2014 Sep 18;371(12):1091-9.[Abstract][Full Text]
98. Gheorghiade M, Patel K, Filippatos G, et al. Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial. Eur J Heart Fail. 2013 May;15(5):551-9.[Abstract][Full Text]
99. Hood WB Jr, Dans AL, Guyatt GH, et al. Digitalis for treatment of heart failure in patients in sinus rhythm. Cochrane Database Syst Rev. 2014 Apr 28;(4):CD002901.[Abstract][Full Text]
100. Heart Failure Society of America. Evaluation and management of patients with acute decompensated heart failure. J Card Fail. 2006 Feb;12(1):e86-103.[Abstract][Full Text]
101. Konstam MA, Gheorghiade M, Burnett JC Jr, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA. 2007 Mar 28;297(12):1319-31.[Abstract][Full Text]
102. Shang W, Zhang Y, Han D. Benefits of tolvaptan on early dyspnea relief in patients with acute heart failure: a meta-analysis. Clin Cardiol. 2022 Oct;45(10):995-1001.[Abstract][Full Text]
103. Ma G, Ma X, Wang G, et al. Effects of tolvaptan add-on therapy in patients with acute heart failure: meta-analysis on randomised controlled trials. BMJ Open. 2019 May 1;9(4):e025537.[Abstract][Full Text]
104. Lu Y, Huang D, Dou C, et al. Clinical efficacy of intravenous cinepazide in the treatment of severe decompensated heart failure. Biomedical Research (India). 2012;23(4):561-5.
105. Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in patients with heart failure and reduced ejection fraction. N Engl J Med. 2020 May 14;382(20):1883-93.[Abstract][Full Text]
106. De Luca L, Mebazaa A, Filippatos G, et al. Overview of emerging pharmacologic agents for acute heart failure syndromes. Eur J Heart Fail. 2008 Feb;10(2):201-13.[Abstract][Full Text]
107. De Luca L, Fonarow GC, Mebazaa A, et al. Early pharmacological treatment of acute heart failure syndromes: a systematic review of clinical trials. Acute Card Care. 2007;9(1):10-21.[Abstract]
108. deGoma EM, Vagelos RH, Fowler MB, et al. Emerging therapies for the management of decompensated heart failure: from bench to bedside. J Am Coll Cardiol. 2006 Dec 19;48(12):2397-409.[Abstract]
109. Teerlink JR, Davison BA, Cotter G, et al. Effects of serelaxin in patients admitted for acute heart failure: a meta-analysis. Eur J Heart Fail. 2020 Feb;22(2):315-29.[Abstract][Full Text]
110. Ensor CR, Russell SD. Tonapofylline: a selective adenosine-1 receptor antagonist for the treatment of heart failure. Expert Opin Pharmacother. 2010 Oct;11(14):2405-15.[Abstract]
111. Massie BM, O'Connor CM, Metra M, et al. Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure. N Engl J Med. 2010 Oct 7;363(15):1419-28.[Abstract][Full Text]
112. Teerlink JR, Felker GM, McMurray JJ, et al; ATOMIC-AHF Investigators. Acute treatment with omecamtiv mecarbil to increase contractility in acute heart failure: the ATOMIC-AHF study. J Am Coll Cardiol. 2016 Mar 29;67(12):1444-55.[Abstract][Full Text]
113. Kuehneman T, Gregory M, de Waal D, et al. Academy of Nutrition and Dietetics evidence-based practice guideline for the management of heart failure in adults. J Acad Nutr Diet. 2018 Dec;118(12):2331-45.[Abstract]
114. Fonarow GC, Adams KF Jr, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005 Feb 2;293(5):572-80.[Abstract][Full Text]
115. Dec GW. Management of acute decompensated heart failure. Curr Probl Cardiol. 2007 Jun;32(6):321-66.[Abstract]
116. Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol. 2017 Nov 14;70(20):2476-86.[Abstract]
117. Aguiló O, Castells X, Miró Ò, et al. The prognostic significance of bundle branch block in acute heart failure: a systematic review and meta-analysis. Clin Res Cardiol. 2023 Aug;112(8):1020-1043.[Abstract]
118. Siurila-Waris K, Lassus J, Melin J, et al. Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure. Eur Heart J. 2006 Dec;27(24):3011-7.[Abstract][Full Text]
119. Benza RL, Tallaj JA, Felker GM, et al. The impact of arrhythmias in acute heart failure. J Card Fail. 2004 Aug;10(4):279-84.[Abstract]