1.4 Initial non-pharmacological treatment 1.4.1 Do not routinely use non-invasive ventilation (continuous positive airways pressure [CPAP] or non-invasive positive pressure ventilation [NIPPV]) in people with acute heart failure and cardiogenic pulmonary oedema. 1.4.2 If a person has cardiogenic pulmonary oedema with severe dyspnoea and acidaemia consider starting non-invasive ventilation without delay: at acute presentation or as an adjunct to medical therapy if the person's condition has failed to respond. 1.4.3 Consider invasive ventilation in people with acute heart failure that, despite treatment, is leading to or is complicated by: respiratory failure or reduced consciousness or physical exhaustion. 1.4.4 Do not routinely offer ultrafiltration to people with acute heart failure. 1.4.5 Consider ultrafiltration for people with confirmed diuretic resistance. Diuretic resistance is defined as dose escalation beyond a person's previously recognised dose ceiling or a dose approaching the maximum recommended daily dose without incremental improvement in diuresis. From diuretics and ultrafiltration in acute decompensated heart failure. 1.5 Treatment after stabilisation 1.5.1 In a person presenting with acute heart failure who is already taking beta-blockers, continue the beta-blocker treatment unless they have a heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock. 1.5.2 Start or restart beta-blocker treatment during hospital admission in people with acute heart failure due to left ventricular systolic dysfunction, once their condition has been stabilised for example, when intravenous diuretics are no longer needed. 1.5.3 Ensure that the person's condition is stable for typically 48 hours after starting or restarting beta-blockers and before discharging from hospital. 1.5.4 Offer an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker if there are intolerable side effects) and an aldosterone antagonist during hospital admission to people with acute heart failure and reduced left ventricular ejection fraction. 