Five million people in the United States are living with heart failure and this number continues to climb. Patients with this chronic disease commonly present to the hospital in what is known as acute decompensated heart failure (ADHF). The prognosis of ADHF is poor, with in-hospital mortality ranging from 4% to 7%, 60- to 90-day mortality ranging from 7% to 11%, and 60- to 90-day rehospitalization rates ranging from 25% to 30%.

A patient experiencing ADHF typically displays shortness of breath (due to low cardiac output), pulmonary edema, or a combination of the two. Patients are classified into 1 of 4 Forrester hemodynamic subsets based on the presenting clinical syndrome (see Figure). This classification system helps health care providers develop appropriate treatment plans using medications such as diuretics, vasodilators, and inotropic agents (Table 1).4–10...

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