Patient handout

Acute decompensated heart failure

PRODUCTION

1. Your condition

This handout is for acute decompensated heart failure. Your care team identified this based on: acute dyspnea / orthopnea / pnd (acc/aha 2022 §10.1).

Other reasons your team may use this plan: pulmonary edema on exam / lung us b-lines (esc 2021 §11); nt-probnp elevated for age (pride, januzzi nejm 2006); sbp <90 or hypoperfusion (scai 2022 cs staging).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
furosemide	IV bolus 2–2.5× total daily home dose (e.g. 80–160 mg IV)	IV	q12h or continuous infusion 5–20 mg/h	DOSE (Felker NEJM 2011) — high-dose intermittent IV loop is reasonable; check urine output at 2 h
torsemide	20–40 mg IV	IV/PO	BID	TRANSFORM-HF (Mentz JAMA 2023) — equivalent outcomes; better PO bioavailability
bumetanide	1–2 mg IV	IV/PO	q4–8h	Alternative loop diuretic (ACC/AHA 2022 §10.3)
acetazolamide	500 mg IV/PO	IV/PO	once daily × 3	ADVOR (Mullens NEJM 2022) — improves decongestion at 3 d when added to loop
metolazone	2.5–10 mg	PO	once daily	CLOROTIC (Trullàs Eur J Heart Fail 2023) — sequential nephron blockade for refractory congestion
hydrochlorothiazide	25 mg	IV/PO	once daily	Alternative thiazide for sequential blockade (ESC 2021 §11.3)
nitroglycerin	5–10 µg/min IV	IV	continuous; titrate by 5 µg/min q5min	Afterload reduction — fastest onset in pulmonary edema (ESC 2021 Class IIa)

Plan: ADHF — wet/cold profile based decongestion + perfusion + GDMT initiation (Nohria-Stevenson 2002; ACC/AHA 2022)

3. When to call your provider

Contact your care team if any of the following happen:

Weight gain ≥3 lb in 24 h or ≥5 lb in 1 week → diuretic titration per protocol or ED (ACC/AHA 2022)
Symptomatic hypotension after ARNI up-titration → hold next dose, recheck in 1 week
K rising > 5.5 → hold MRA first, consider K binder
Cr rise >30% from discharge baseline → reduce diuretic; reassess volume; route to ED if AKI symptomatic
NYHA worsening to III+ → expedite cardiology re-evaluation (ACC/AHA 2022 Class I)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

SBP <90 + lactate ≥2 + hypoperfusion (cool extremities, AKI, AMS) — SCAI 2022 C+(life-threatening)
Flash pulmonary edema + SBP >180 + acute respiratory failure (ESC 2021 §11)
New ECG ischemia / arrhythmia (AF with RVR, VT) precipitating decompensation (ACC/AHA 2022 §10.2)

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline + 2023 AHA/ACC/HFSA Focused Update + 2021/2023 ESC HF