Rapid Clinical Assessment of Hemodynamic Profiles and Targeted Treatment of Patients with Acutely Decompensated Heart Failure

Summary: Acutely decompensated heart failure (ADHF) is characterized by hemodynamic abnormalities and neurohor-monal activation that contribute to heart failure (HF) symp-toms, end-organ dysfunction, arrhythmias, and progressive cardiac failure. The management of ADHF in the emergency department (ED) can be simplified and improved by a 2-min bedside assessment that identifies any of four possible hemo-dynamic profiles on the basis of clinical signs and symptoms. The profiles are based on whether congestion is present or ab-sent (wet or dry) and perfusion is adequate or limited (warm or cold). A wet-warm profile is seen more frequently in the ED than any of the other three profiles (wet-cold, dry-warm, and dry-cold). The four clinically determined profiles have been shown to predict clinical outcomes and may be used to guide initial HF therapy. The goals of treating ADHF are to stabiliz