Heart attackThe first European advice on emergency care for patients with acute heart failure has been published in European Heart Journal: Acute Cardiovascular Care.

Acute heart failure is a chronic disorder that flares up and leads to emergency visits. The vast majority of patients present to an emergency department with sudden and severe shortness of breath (called acute dyspnoea) at rest. In 50% of patients the underlying condition is chronic heart failure. The remainder could have had a heart attack 10 years ago, or their underlying heart condition is undiagnosed. Most cases of acute heart failure cannot be cured, although the flares can be treated.

The new paper focuses on the decision on whether to discharge patients with acute heart failure from the emergency department and see them as outpatients, or to admit them to hospital. Until now there was no guidance on this issue. The result is that emergency physicians have tended to act conservatively and admit patients to hospital. The paper outlines criteria to help clinicians select patients that can be safely discharged. A novel algorithm shows the order of decisions to be made and what to consider at each step.

Additionally, the paper emphasises the importance of long-term follow up, regardless of whether patients are discharged directly from the emergency department or spend a period in hospital before being sent home. Follow-up planning should be done by the emergency team in collaboration with the GP, cardiologist and others involved in the patient’s long-term care.

Professor Christian Mueller, chair of the Acute Heart Failure Study Group of the Acute Cardiovascular Care Association of the European Society of Cardiology, said: “Mortality from acute heart failure is even higher than from a heart attack so it is an urgent situation.

“Only half of patients discharged from hospital with acute heart failure are alive in three years, even though they felt fine. Despite the severity of the condition there are no standard treatment pathways, whereas these were agreed across Europe for heart attack 30 years ago. The paper published today is the first step towards catching up with heart attack care and establishing similar standards for acute heart failure.

“The hospital is not always the best place to care for acutely ill patients. While in hospital, patients with acute heart failure – who are 78 years old on average – are at risk of developing infections and they have problems sleeping. There is also pressure on hospitals to avoid expensive admissions when possible. But patients do benefit from more intense follow up while in hospital.

“The paper aims to kick start the process of emergency medicine physicians and cardiologists joining forces to apply or adjust the algorithm so that it works locally. The patient pathway and decisions on place of treatment will vary depending on reimbursement policies and logistics.”