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10.1 Acute heart failure: diagnostic and prognostic assessment
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Published:November 2023
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Abstract
Acute heart failure (AHF) refers to rapid or gradual onset or worsening of symptoms and/or signs of HF, reflecting diverse abnormalities of congestion and/or hypoperfusion status, leading to unplanned hospital admission, ED visit, or outpatient visit. AHF requires urgent evaluation with subsequent initiation of the treatment. The diagnostic workup must start at the time of the first medical contact and be continued throughout the initial patient pathway. Initial diagnosis should be based on clinical judgment to integrate patient history with physical examination. Since the sensitivity and specificity of symptoms and signs are only modest, diagnosis of AHF should be further confirmed by appropriate additional investigations, such as biomarkers, ECG, chest X-ray, lung ultrasound, laboratory assessment, and echocardiography. During the diagnostic process, coexisting life-threatening clinical conditions or precipitants that require urgent correction need to be immediately identified and managed. The diagnostic workup should continue with the identification of clinical phenotypes, acutely decompensated HF, acute pulmonary oedema, acute right failure, and cardiogenic shock, that would support the initiation of the early individualized treatments.
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