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cardio.acute-hf.core.v1

Acute decompensated heart failure

cardiologyacuteadultacuteinpatienttransitionoutpatient
Start encounter →Print handoutPRODUCTION

Profile-based regimen ladder authored (warm-wet / cold-wet / cold-dry / GDMT in-hospital) with RxCUIs from cardio.acute-hf.core.v1.atoms.treatment.ts; 5 setting playbooks (ED, inpatient, ICU, transition, outpatient); six severity triggers (cardiogenic shock, flash pulmonary edema, diuretic resistance, cardiorenal worsening, hyperK on GDMT, ACS precipitant). shard-06 deepening pass 2026-05-14: replaced 2 SUSPECTED_FABRICATION PMIDs with 11 verified ADHF anchors (DanGer Shock 2024 PMID 38587239, ECLS-SHOCK 2023 PMID 37634145, AFFIRM-AHF PMID 33197395, IRONMAN PMID 36347265, SOAP-II PMID 20200382, OPTIME-CHF PMID 11911756, Maisel BNP PMID 12124404, PRIDE NT-proBNP PMID 15820160, Lichtenstein BLUE PMID 18403664, 3CPO PMID 18614781, MAGGIC PMID 23095984); added MAGGIC + CHA2DS2-VASc band-mapped calculators; transition + outpatient playbooks for STRONG-HF post-discharge bridge; co-located _design-brief.md + _research-bundle.md authored; ROS/DDx/LR seed files for engine seeded (13 ROS + 10 ddx + 27 LR rows incl. Wang 2005 + Maisel BNP + Januzzi PRIDE + Lichtenstein BLUE anchors). Terminology codes embedded in the manifest (SNOMED/ICD-10/LOINC) — backfill arrays here once a parser is wired (avoids hand-copying drift). Engine-specific panel src/components/panels/cardio/acute-hf-panel.tsx wired into cardio-acute-panel-router; 5 vitest panel tests passing.

Entry points (5)

  • symptom
    Acute dyspnea / orthopnea / PND (ACC/AHA 2022 §10.1)
    acute_dyspnea
  • symptom
    Pulmonary edema on exam / lung US B-lines (ESC 2021 §11)
    acute_pulmonary_edema
  • lab_abnormality
    NT-proBNP elevated for age (PRIDE, Januzzi NEJM 2006)
    nt_probnp_elevated
  • vital_abnormality
    SBP <90 or hypoperfusion (SCAI 2022 CS staging)
    hypotension_or_hypoperfusion
  • problem_list
    Known HF with new decompensation (ACC/AHA 2022 Class I)
    chronic_hf_decompensation

Required inputs (13)

  • agerequired
    demographic • used at CONTEXT
    Age-adjusted NT-proBNP cutoffs (PRIDE, Januzzi NEJM 2006)
  • sbprequired
    vital • used at RED_FLAGS
    Wet-warm vs wet-cold profile; CS triggers MCS pathway (ESC 2021 §11; SCAI 2022)
  • spo2required
    vital • used at RED_FLAGS
    NIPPV indication per 3CPO (Gray NEJM 2008); hypoxic respiratory failure
  • rrrequired
    vital • used at RED_FLAGS
    Respiratory failure trigger (ACC/AHA 2022 §10.1)
  • nt_probnprequired
    lab • used at INITIAL_WORKUP
    Diagnostic + risk; trended to assess decongestion (ACC/AHA 2022 Class I; ESC 2021)
  • creatininerequired
    lab • used at CONTEXT
    Cardiorenal syndrome; loop diuretic dosing; SGLT2i gating (ACC/AHA 2022)
  • potassiumrequired
    lab • used at CONTEXT
    Diuresis-driven hypoK; MRA gating per RALES/EMPHASIS-HF (ACC/AHA 2022)
  • lactate
    lab • used at RED_FLAGS
    Hypoperfusion marker / SCAI 2022 CS stage classification
  • lvef
    imaging • used at DIFFERENTIAL
    Wet-warm/wet-cold matrix + GDMT initiation in-hospital (ACC/AHA 2022 Class I)
  • lung_us
    imaging • used at INITIAL_WORKUP
    BLUE protocol B-lines for AHF vs COPD (Lichtenstein Chest 2008)
  • cxr
    imaging • used at INITIAL_WORKUP
    Pulmonary edema, cardiomegaly, alternate diagnoses (ESC 2021 §11)
  • current_meds
    history • used at CONTEXT
    Detect home loop diuretic dose for IV escalation 1×–2.5× (DOSE, Felker NEJM 2011)
  • precipitant
    history • used at BRANCHING_WORKUP
    AF/ACS/HTN/non-adherence/infection drives co-management (ACC/AHA 2022 §10.2)

12-phase flow (11)

  1. 1FRAME
    Confirm acute decompensation per ACC/AHA 2022 §10.1; chronic HF titration routes to cardio.hf.core.v1
    inputs: sbp, spo2
    advance: patient is acutely decompensated (volume overload / hypoperfusion)
  2. 2ENTRY
    Capture trigger (dyspnea / edema / known HF) + demographics per ESC 2021 §11 diagnostic algorithm
    inputs: age
    advance: one entry trigger present
  3. 3CONTEXT
    Vitals, current GDMT/diuretic dose, comorbidities (ACC/AHA 2022 Class I)
    inputs: sbp, creatinine, potassium, current_meds
    advance: context complete
  4. 4RED_FLAGS
    Cardiogenic shock (SCAI 2022), respiratory failure, ACS, severe hyperK
    inputs: sbp, spo2, lactate
    actions: cardiogenic_shock, acs_pathway
    advance: red flags screened or escalated
  5. 5INITIAL_WORKUP
    NT-proBNP (PRIDE), BMP, troponin, ECG, CXR, lung US (BLUE protocol), echo per ESC 2021
    inputs: nt_probnp, lung_us, cxr
    actions: panel.cardiac, panel.renal
    advance: baseline labs + imaging documented
  6. 6BRANCHING_WORKUP
    Identify precipitant — AF, ACS, HTN, infection, non-adherence (ACC/AHA 2022 §10.2)
    inputs: precipitant
    actions: acute_pulm_edema
    advance: precipitant identified or empirical management initiated
  7. 7DIFFERENTIAL
    Wet-warm / wet-cold / dry-cold / dry-warm matrix per Nohria-Stevenson 2002; HFrEF vs HFpEF (ACC/AHA 2022)
    inputs: lvef
    advance: profile assigned
  8. 8RISK_STRATIFICATION
    SCAI 2022 CS staging if hypoperfused; OPTIMIZE-HF / GWTG-HF risk scoring
    inputs: sbp, lactate, creatinine
    advance: risk class documented
  9. 9TREATMENT
    IV loop diuretic (DOSE, Felker NEJM 2011), NIPPV (3CPO), nitrates, acetazolamide (ADVOR, Mullens NEJM 2022), in-hospital GDMT (PIONEER-HF, EMPULSE)
    inputs: sbp, creatinine, potassium
    actions: protocol.cardiogenic_shock
    advance: decongestion strategy active and GDMT plan started before discharge
  10. 10DISPOSITION
    Floor vs ICU/CICU; STRONG-HF (Mebazaa Lancet 2022) early follow-up plan
    advance: unit + follow-up cadence assigned
  11. 11MONITORING
    Daily weight, I/O, BMP q24h during diuresis, NT-proBNP trend (ACC/AHA 2022 Class I)
    inputs: creatinine, potassium
    actions: panel.renal
    advance: monitoring plan documented