Acute Heart Failure Management and Outcomes

Acute heart failure encompasses both new‐onset presentations and decompensation of chronic disease, characterised by rapid onset of symptoms such as breathlessness, fluid overload and organ hypoperfusion. Management begins with prompt clinical and haemodynamic assessment to stratify risk and identify precipitating factors, which commonly include infection, arrhythmia, uncontrolled hypertension and non-adherence to therapy. Intravenous diuretics remain first‐line for decongestion, often combined with vasodilators or inotropes in hypotensive or low‐output states. Biomarker monitoring—particularly B-type natriuretic peptide—guides intensity of therapy and timing of discharge. Multidisciplinary approaches involving cardiologists, primary care practitioners and nursing teams are essential to optimise medication titration, patient education and early follow-up. Despite advances, acute episodes carry substantial morbidity, with high rates of rehospitalisation and one-year mortality. Global efforts focus on infection prevention, remote monitoring technology and personalised care pathways to improve outcomes across diverse healthcare settings.

Research from Nature Portfolio

Recent studies have explored the impact of infection on long-term cardiovascular prognosis in acute heart failure. A large national cohort analysis demonstrated that patients readmitted within one year of discharge for infection experienced significantly higher rates of major adverse cardiovascular events, including all-cause mortality, myocardial infarction, stroke and recurrent heart failure hospitalisation. These findings underscore the importance of integrated infection control measures and post-discharge surveillance to reduce adverse outcomes in this high-risk population.

Acute Heart Failure Management and Outcomes publication trend

The graph below shows the total number of articles in acute heart failure management and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Acute decompensated heart failure: A sudden worsening of cardiac function leading to fluid overload and end-organ hypoperfusion.

B-type natriuretic peptide (BNP): A cardiac biomarker released in response to ventricular stretch, used to monitor congestion and guide therapy.

Left ventricular ejection fraction (LVEF): The proportion of blood ejected from the left ventricle with each heartbeat, expressed as a percentage.

Major adverse cardiovascular events (MACE): A composite outcome including death, myocardial infarction, stroke and heart failure hospitalisation.

Sepsis: A life-threatening organ dysfunction caused by a dysregulated response to infection, commonly precipitating heart failure decompensation.

References

1. Impact of infection-related admission in patients with heart failure: a 10 years national cohort study. Scientific Reports (2023).
2. Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care. Scandinavian Journal of Primary Health Care (2020).
3. Relation of Decongestion and Time to Diuretics to Biomarker Changes and Outcomes in Acute Heart Failure. The American Journal of Cardiology (2021).
4. Prevalence and Predictors of Sepsis Death in Patients With Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction. Journal of the American Heart Association (2018).