Assessment in hospital

Assessment in hospital



Acute Heart Failure (AHF) refers to rapid or gradual onset of symptoms and/or signs of heart failure, severe enough for the patient to seek urgent medical attention.

Commonly leads to an unplanned hospital admission or an emergency department visit.

AHF is a leading cause of hospitalisations in subjects aged >65 years and is associated with high mortality and rehospitalisation rates.

In-hospital mortality ranges from 4% to 10%.

Post-discharge 1-year mortality can be 25-30% with up to more than 45% deaths or readmission rates.

Principles of Acute Heart Failure assessment

Diagnostic workup and appropriate pharmacological and non-pharmacological treatment must be started promptly and in parallel.

AHF patients must be triaged to the appropriate level of care according to the degree of haemodynamic instability and severity of the critical illness. Disposition decisions are important components of the initial phase of management.

The type and intensity of in-hospital monitoring depends on clinical severity, settings of care and in-hospital course. As AHF is a heterogeneous condition, management may differ according to the main clinical presentation.

Management starts with the search for specific causes of AHF. These include ACS, a hypertensive emergency, rapid arrhythmias or severe bradycardia/conduction disturbance, acute mechanical causes such as acute valve regurgitation or acute pulmonary embolism, infection, including . myocarditis, and tamponade (CHAMPIT). After exclusion of these conditions, which need to be treated/corrected urgently, management of AHF differs according to the clinical presentations.

It is imperative to engage with your local HF/Cardiology team ASAP (see local guidelines).

  • Worsening shortness of breath or new shortness of breath at rest.
  • Reduced exercise tolerance/capacity
  • Fatigue
  • Increased pillows at night (orthopnoea) or frequent wakening due to cough or breathlessness (PND)
  • Confusion
  • Low BP
  • Increased Heart Rate
  • Increased respiratory rate
  • Low oxygen saturations (compare with previous observations if available)
  • Increased weight of ≥2kgs in 3 days
  • Pulmonary congestion
  • Pulmonary oedema
  • Pulmonary crepitations
  • Elevated JVP
  • Peripheral oedema
  • Oliguria

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(c) British Society for Heart Failure, 2022-
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