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Improving Postdischarge Outcomes in Acute Heart Failure

The global burden that acute heart failure (AHF) carries has remained unchanged over the past several decades.1 European registries2–5 showed that 1-year outcome rates remain unacceptably high (Table 1) and confirm that hospitalization for AHF represents a change in the natural history of the disease process.6 Because patients hospitalized for heart failure (HF) have a bad prognosis, it is crucial to use hospitalization as an opportunity to: (1) assess the individual components of the cardiac substrate; (2) identify and treat comorbidities; (3) identify early, safe end points of therapy to facilitate timely hospital discharge and outpatient follow-up; and (4) implement and begin optimization of guideline-directed medical therapies (GDMTs). As outcomes are influenced by many factors, many of which are incompletely understood, a systematic approach is proposed that should start with admission and continue through postdischarge.7 This review provides practical recommendations on HF management during the time of hospitalization and aims to summarize key lessons from clinical trials and registries in AHF (Table 2).