Editorial Classification of Patients With Acute Heart Failure Syndromes in the Emergency Department

Hospitalization for acute heart failure syndromes (AHFS)heralds a grim prognosis: More than one third of patients will be dead or rehospitalized within 90 days post-discharge.1 Although total hospitalizations for AHFS have decreased over the past decade, rehospitalization rates have not.2,3 With 1 million hospitalizations annually at an esti-mated cost exceeding $20 billion, AHFS is a major public health problem.4 Article see p 17 One of the possible contributors to these poor outcomes is our approach to patients with AHFS in the emergency department (ED). Approximately 80 % of hospitalized pa-tients initially present to the ED, highlighting the pivotal role of the ED in initial AHFS management.5 Yet there are no class I, level A guideline recommendations for the initial pharmacological treatment of AHFS.6 ED treatment today i