ACEP Clinical Policy — Acute Heart Failure Management in the ED (2022)

The ACEP 2022 Clinical Policy on evaluation and management of acute decompensated heart failure (ADHF) in the emergency department synthesizes evidence for initial diagnosis, risk stratification, and treatment decisions — with emphasis on high-dose IV diuresis, vasodilator therapy, non-invasive ventilation, and identifying patients who require emergent mechanical support versus those safe for ED-based treatment and early discharge. Heart failure is the leading cause of hospitalization in adults over 65, and the ED encounter is critical for reversing acute fluid overload and determining safe disposition.