Acute heart failure

ebpracticenet urges you to prioritise the following organisational guidance:

Consider interventions aimed at modifying risk factors in order to delay or prevent the onset of acute heart failure, including:[1]

Coronary artery disease: manage with aspirin, beta-blockers, statins, and ACE inhibitors, as needed
- Optimising treatment of hypertension, smoking cessation, and lipid control provides substantial benefit in patients with coronary artery disease.[1]
- Optimal control of hypertension often requires more than one antihypertensive medication.[23] Different antihypertensive drugs (diuretics, ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers) have been shown to be effective, especially in older people, both with and without a history of myocardial infarction.[1]
Diabetes mellitus: in addition to metabolic control, ensure aggressive control of lipids and blood pressure.[24] Use sodium-glucose cotransporter 2 (SGLT2) inhibitors (e.g., dapagliflozin or empagliflozin) for patients with type 2 diabetes and either established cardiovascular disease or at high cardiovascular risk to prevent hospitalisations for heart failure, irrespective of whether they have an existing heart failure diagnosis (HFpEF or HFrEF).[1][2] Patients with diabetes taking SGLT2 inhibitors are at increased risk of developing diabetic ketoacidosis (including euglycaemic ketoacidosis).[25]
Alcohol consumption and excessive salt and fluid intake: discourage in patients with known left ventricular dysfunction.[1]
Drugs that can cause or potentiate heart failure: avoid, if safe and possible to do so.[26]

Secondary prevention

All patients with heart failure are recommended to have pneumococcal, COVID-19 and annual influenza vaccination.[1][87]

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