Disposition of acute decompensated heart failure from the emergency department: An evidence-based review

Ioana Rider, Matthew Sorensen, William J. Brady, Michael Gottlieb, Scarlet Benson, Alex Koyfman, Brit Long

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Introduction: Acute heart failure (HF) exacerbation is a serious and common condition seen in the Emergency Department (ED) that has significant morbidity and mortality. There are multiple clinical decision tools that Emergency Physicians (EPs) can use to reach an appropriate evidence-based disposition for these patients. Objective: This narrative review is an evidence-based discussion of clinical decision-making tools aimed to assist EPs risk stratify patients with AHF and determine disposition. Discussion: Risk stratification in patients with AHF exacerbation presenting to the ED is paramount in reaching an appropriate disposition decision. High risk features include hypotension, hypoxemia, elevated brain natriuretic peptide (BNP) and/or troponin, elevated creatinine, and hyponatremia. Patients who require continuous vasoactive infusions, respiratory support, or are initially treatment-resistant generally require intensive care unit admission. In most instances, new-onset AHF patients should be admitted for further evaluation. Other AHF patients in the ED can be risk stratified with the Ottawa HF Risk Score (OHFRS), the Multiple Estimation of Risk Based on Spanish Emergency Department Score (MEESSI), or the Emergency HF Mortality Risk Grade (EHFMRG). These tools take various factors into account such as mode of arrival to the ED, vital signs, laboratory values like troponin and pro-BNP, and clinical course. If used appropriately, these scores can predict patients at low risk for adverse outcomes. Conclusion: This article discusses evidence-based disposition of patients in acute decompensated HF presenting to the ED. Knowledge of these factors and risk tools can assist emergency clinicians in determining appropriate disposition of patients with HF.

Original languageEnglish (US)
Pages (from-to)459-465
Number of pages7
JournalAmerican Journal of Emergency Medicine
StatePublished - Dec 2021


  • Acute heart failure
  • Decision tool
  • Disposition
  • Evidence

ASJC Scopus subject areas

  • Emergency Medicine


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