Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Contents Overview 4 Who is it for? 4 Introduction 5 Drug recommendations 5 Key priorities for implementation 7 Organisation of care 7 Diagnosis, assessment and monitoring 7 Treatment after stabilisation 8 1.1 Organisation of care 9 1.2 Diagnosis, assessment and monitoring 10 1.3 Initial pharmacological treatment 10 1.4 Initial non-pharmacological treatment 11 1.5 Treatment after stabilisation 12 1.6 Valvular surgery and percutaneous intervention 13 1.7 Mechanical assist devices 13 2 Recommendations for research 14 2.3 Intra-aortic balloon counter-pulsation 15 Finding more information and committee details 17 Update information 18 This guideline is partially replaced by NG208. This guideline is the basis of QS103. Overview This guideline covers diagnosing and managing acute heart failure or possible acute heart failure in people aged 18 and over. It aims to improve the immediate care of someone who is acutely unwell as a result of heart failure. Heart failure may indicate acute myocardial injury in patients with COVID-19. See the recommendations on diagnosing and managing acute myocardial injury in our COVID-19 rapid guideline on managing COVID-19. Who is it for? Healthcare professionals Commissioners Adults who have a diagnosis of acute heart failure, or have possible acute heart failure, or are being investigated for acute heart failure Introduction Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. It is caused by dysfunction of the heart due to muscle damage (systolic or diastolic dysfunction), valvular dysfunction, arrhythmias or other rare causes. Acute heart failure can present as new-onset heart failure in people without known cardiac dysfunction, or as acute decompensation of chronic heart failure. 