Heart failure (HF) has a high incidence and prevalence in the USA and worldwide. It is
a very common cause of significant morbidity and mortality with serious cost implications on the
US health sector. The primary focus of this review is to synthesize an effective comprehensive
care plan for patients in acute decompensated heart failure (ADHF) based on the most current
evidence available. It begins with a brief overview of the pathophysiology, clinical presentation
and evaluation of patients in ADHF. It then reviews management goals and treatment guidelines,
with emphasis on challenges presented by diuretic resistance and worsening renal function (WRF).
It provides information on recognition of advanced HF even during acute presentation, estimation
of prognosis and proactive identification of patients that will benefit from mechanical cardiac
devices, transplantation and palliative care/hospice. In addition, it presents strategies to address
the problem of readmissions, which is an ominous prognostic factor with enormous economic
Keywords: ADHF, diuretic resistance, ultrafiltration, cardiorenal syndrome, re-hospitalization, palliative care.
Rights & PermissionsPrintExport