Management of decompensated heart failure

Hospitalizations for heart failure have increased threefold during the past 3 decades, and this trend is expected to continue for the next 25 years. Heart failure now is the largest single expense for Medicare, and hospitalizations account for more than half of these costs. Most hospitals sustain financial losses with heart failure management because expenses exceed reimbursement. The hospital emergency department often is the initial encounter site for patients with new-onset heart failure, but most heart failure emergency department visits are for recurrent decompensation. The majority of these patients will be admitted to the hospital. Although accurate diagnosis and effective treatment are important for improving outcomes and lowering costs, there are no published guidelines for managing acutely decompensated heart failure. This review describes new diagnostic and management strategies, utilizing the emergency department observational unit as a triage area, that may decrease hospital length of stay, reduce hospital costs, and prevent readmissions.