(Level of Evidence: C) 7.5. Parenteral Therapy in Hospitalized HF CLASS IIb 1. If symptomatic hypotension is absent, intravenous nitro- glycerin, nitroprusside, or nesiritide may be considered an adjuvant to diuretic therapy for relief of dyspnea in patients admitted with acutely decompensated HF (320 323). (Level of Evidence: A) 7.6. Venous Thromboembolism Prophylaxis in Hospitalized Patients CLASS I 1. A patient admitted to the hospital with decompensated HF should receive venous thromboembolism prophylaxis with an anticoagulant medication if the riskLbene t ratio is favorable (22,324 328). (Level of Evidence: B) 7.7. Arginine Vasopressin Antagonists CLASS IIb 1. In patients hospitalized with volume overload, including HF, who have persistent severe hyponatremia and are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT, vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hypona- tremic states with either a V2 receptor selective or a nonselective vasopressin antagonist (330,331). (Level of Evidence: B) 7.8. Inpatient and Transitions of Care See Table 23 for a summary of recommendations from this section. CLASS I 1. The use of performance improvement systems and/or evidence-based systems of care is recommended in the hospital and early postdischarge outpatient setting to identify appropriate HF patients for GDMT, provide clinicians with useful reminders to advance GDMT, and assess the clinical response (151,332 338). (Level of Evidence: B) 2. Throughout the hospitalization as appropriate, before hospital discharge, at the rst postdischarge visit, and in Table 23. 