A Comparison of Different Guidelines for the Treatment of Acute Heart Failure and Their Extensibility to Emergency Departments: A Critical Reappraisal

Abstract

Background/Objectives: Acute heart failure (AHF) is a common cause of emergency department (ED) referral. Different guidelines aim to optimise this condition, but the evidence is poor for most indications regarding AHF. In this paper, we aim to (i) identify the five most interesting topics in AHF management, (ii) compare guidelines, and (iii) give the reader the best advice on how to manage AHF in each topic. Methods: The working group (WG) identified ten critical topics in AHF management using a Delphi method and submitted them to ITEMS, a national group of ED physicians that ranked them. The WG selected the five highest-ranked topics and performed a critical reappraisal of guidelines. Lastly, the WG prepared the answers for ED physicians according to the guidelines and comparisons of studies. Results: The WG identified five topics for ED patients with AHF: (i) what is the optimal oxygen and ventilatory support, (ii) what is the optimal dose and administration modality of diuretics, (iii) what is the role of inotropes and vasopressors, (iv) what therapeutic strategies are suggested for diuretic refractoriness, and (v) what is the diagnostic role of lung ultrasound. For each topic, the WG identified, summarised, and compared the indications provided by each guideline, generating advice for ED management of AHF after a critical literature reappraisal. Conclusions: We highlighted the differences among guidelines dealing with AHF and developed the five best recommendations to assist ED physicians in determining the optimal approach for the ED management of AHF and to suggest future research directions.