Current ESC/ESICM and ACCF/AHA guidelines for the diagnosis and management of acute heart failure in adults: are there differences?

Abstract

There are many similarities between the recommendations of the European and American societies (i.e., the European Society of Cardiology, the European Society of Intensive Care Medicine, the North American College of Cardiology, and the American Heart Association) on the management of acute heart failure (AHF). There is a consensus that the symptoms of AHF should be relieved as rapidly as possible, which requires combining oxygen, noninvasive ventilation, vasodilators, and diuretics. There is also a consensus that long-lasting oral treatments such as beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers should be administered to patients unless they are hemodynamically unstable. The diagnosis of AHF is based on clinical signs. However, electrocardiography and chest X-ray should be performed in all AHF patients. Natriuretic peptides should be measured in doubtful cases to either confirm or exclude the diagnosis of AHF. Echocardiography should be promptly performed by cardiologists. Because a unanimous consensus between European and North American societies has now been reached, the next step is to apply the guidelines in all medical units worldwide in order to minimize morbidity and mortality of AHF patients.