ACS precipitating acute HF decompensation should be promptly identi ed by electrocardiogram and serum biomarkers, including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prog- nosis of the patient. (Level of Evidence: C) 2. Common precipitating factors for acute HF should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy. (Level of Evidence: C) 7.2. Maintenance of GDMT During Hospitalization CLASS I 1. In patients with HFrEF experiencing a symptomatic exac- erbation of HF requiring hospitalization during chronic maintenance treatment with GDMT, it is recommended that GDMT be continued in the absence of hemodynamic insta- bility or contraindications (307 309). (Level of Evidence: B) 2. Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinua- tion of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Caution should be used when initiating beta blockers in patients who have required inotropes during their hospital course (307 309). (Level of Evidence: B) 7.3. Diuretics in Hospitalized Patients CLASS I 1. Patients with HF admitted with evidence of signi cant uid overload should be promptly treated with intravenous loop diuretics to reduce morbidity (310,311). (Level of Evidence: B) 2. If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose and should be given as either intermittent boluses or continuous infusion. Urine output and signs and symptoms of congestion should be serially assessed, and the diuretic dose should be adjusted accordingly to relieve symptoms, reduce volume excess, and avoid hypotension (312). (Level of Evidence: B) Table 22. 