Current Heart Failure Reports

, Volume 16, Issue 1, pp 12–20 | Cite as

Early Treatment in Emergency Department Patients with Acute Heart Failure: Does Time Matter?

  • Anna Marie ChangEmail author
  • Peter S. Pang
  • Javed Butler
  • Alan B. Storrow
  • Phillip D. Levy
  • JoAnn Lindenfeld
  • Sean P. Collins
Emergency Medicine (F Peacock, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Emergency Medicine


Purpose of Review

Acute heart failure accounts for over one million hospital discharges annually. Current guidelines suggest treatments for AHF should begin “without delay” but this time interval has not been clearly defined.

Recent Findings

Data suggest that certain treatments such as earlier treatment with diuretics and vasodilators may improve patient symptom relief, morbidity, and mortality. Secondary analyses of clinical trials of novel treatments under development have not shown similar results.


The data are equivocal regarding the impact of early treatment in AHF on in-hospital and long-term morbidity and mortality. Improved clinical trial designs will help answer when and if “early” treatment should begin and whether it impacts short- and long-term outcomes in AHF.


Acute heart failure Emergency medicine Treatments for AHF 


Compliance with Ethical Standards

Conflict of Interest

Alan Storrow: Consultant for Quiedel, Siemens, Novartis. Grant support from NIH, AHRQ, and PCORI.

Sean Collins: Consulting- Medtronic, Novartis, Ortho Clinical, Vixiar. Research support - NIH, PCORI, AHRQ, AHA.

Peter Pang: Consultant for: Baxter, BMS, Novartis. And has received research or other support from: BMS, Roche, Novartis, PCORI, AHA, NHLBI, AHRQ, OrthoDiagnostics, Abbott.

Phillip Levy: Consultant for: Apex Innovations, Astra Zeneca, Mespere, Novartis, Ortho Diagnostics, Roche Diagnostics, Veravas, Shire, Siemens, Hospital Quality Foundation. Research Support: Amgen, Arterez, Beckman Coulter, AHRQ, BCBSMF, EMF, MDHHS, PCORI, NIH/NIMHD, NIH/NHLBI.

Javed Butler has received research support from the NIH and European Union, and has served as a consultant to Amgen, Astra-Zeneca, Bayer, Boehringer Ingelheim, BMS, CVRx, Janssen, Medtronic, Merck, Novartis, Relypsa and Vifor.

Anna Marie Chang: research support: Beckman Coulter, Bristol Meyers Squibb, Ortho Clinical Diagnostics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Anna Marie Chang
    • 1
    Email author
  • Peter S. Pang
    • 2
  • Javed Butler
    • 3
  • Alan B. Storrow
    • 4
  • Phillip D. Levy
    • 5
  • JoAnn Lindenfeld
    • 6
  • Sean P. Collins
    • 4
  1. 1.Department of Emergency MedicineThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Department of Emergency MedicineIndiana UniversityIndianapolisUSA
  3. 3.Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA
  4. 4.Department of Emergency MedicineVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of Emergency MedicineWayne State UniversityDetroitUSA
  6. 6.Department of Medicine, Division of CardiologyVanderbilt University Medical CenterNashvilleUSA

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