Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes Approved by ACEP Board of Directors, June 23, 2022

This clinical policy from the American College of Emergency Physicians is a revision of the 2007 "Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Acute Heart Failure Syndromes." A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients presenting to the emergency department with suspected acute heart failure syndrome, is the diagnostic accuracy of point-of-care lung ultrasound sufficient to direct clinical management? (2) In adult patients presenting to the ED with suspected acute heart failure syndrome, is early administration of diuretics safe and effective? (3) In adult patients presenting to the ED with suspected acute heart failure syndrome, is vasodilator therapy with high-dose nitroglycerin administration safe and effective? (4) In adult patients presenting to the ED with symptomatic acute heart failure syndrome, is there a defined group that may be discharged directly home for outpatient follow-up? Evidence was graded, and recommendations were made on the basis of the strength of the available data.