Contemporary Management of Acute Heart Failure From Emergency Presentation to Long-Term Remission

Abstract

Acute heart failure (AHF) represents a major global health challenge, with a substantial impact on survival, morbidity, and health care resource utilization. The clinical and economic burden associated with this condition continues to grow, highlighting the need for a timely, structured, and patient-centered approach to care. In light of the expanding body of data and evidence accumulated over recent years, it is necessary to rethink how we approach the recognition and management of AHF. This need has motivated the development of the present review, which aims to provide an updated and practical synthesis of the management of AHF-from early diagnostic assessment and decongestive strategies to the initiation of guideline-directed medical therapy and planning for outpatient transition. The goal is to outline an integrated, holistic, and patient-centered care pathway to facilitate timely recognition and access to guideline-directed medical therapies for AHF. This document is the result of collaboration among an international panel of clinicians with expertise in AHF management. The aim is to offer guidance that is globally applicable across a wide range of clinical settings. Particular attention has been paid to ensuring that the proposed recommendations reflect diverse health care needs while addressing key challenges and threats in the management of patients with AHF. By aligning clinical strategies with patient needs and system capabilities, this review seeks to advance the quality and consistency of AHF care worldwide. (JACC. 2026;87:3632-3650) (c) 2026 the American College of Cardiology Foundation. Published by Elsevier. All rights are reserved, including those for text and data mining, AI training, and similar technologies.