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First European advice launched for acute heart failure.

Mortality is still high so it is an urgent situation. Despite the severity of the condition there are no standard treatment pathways, whereas these were agreed across Europe forMI 30 years ago. The article, led by Professor Oscar Miro and Professor Frank Peacock is the first step towards catching up with MI care and establishing similar standards for acute heart failure. The published article focuses on the pivotal decision of 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 has been no guidance on this issue. The result is that some emergency physicians may have tended to act too conservatively and admit all patients to hospital, while other emergency physicians may have tended to be too liberal to discharge patients home. The article outlines criteria to help clinicians select patients that can be safely discharged from the emergency department. A novel algorithm (Figure 1) shows the order of decisions to be made and what to consider at each step. 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. The importance of long-term follow-up is emphasized, 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 general practitioner (GP), cardiologist, and others involved in the patient’s longterm care. It’s never ever possible to treat acute heart failure sufficiently in 24 h in the emergency department so intense follow-up will always be needed. It’s the task of the emergency department physician to either