• Robert J DiDomenico, Hayley Y Park, Mary Ross Southworth, Heather M Eyrich, Richard K Lewis, Jamie M Finley, and Glen T Schumock.
• Department of Pharmacy Practice, Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL 60612-7230, USA.
• Ann Pharmacother. 2004 Apr 1;38(4):649-60.

ObjectiveTo describe the development of guidelines for the treatment of acute decompensated heart failure (ADHF) in the emergency department/observation unit (ED-OU) setting for hospitals that are part of a group purchasing organization (GPO).Data SourcesA MEDLINE search (1966-March 2003) using the following search terms: cardiotonic agents; diuretic; dobutamine; heart failure, congestive; milrinone; natriuretic peptide, brain; nesiritide; nitroglycerin; vasodilator agents, was conducted.Study Selection And Data ExtractionRelevant articles in the English language were identified. All randomized studies and meta-analyses for each category of drugs were included.Data SynthesisA group consensus method was used to develop guidelines. An expert panel reviewed and revised the guidelines. The final guidelines were approved June 1, 2003, and are described here. They are organized based upon a patient's symptomatology at the time the diagnosis of ADHF is made. Patients with evidence of volume overload require intravenous diuretics and/or intravenous vasodilators to alleviate the symptoms of ADHF. Patients with signs and symptoms of low cardiac output require inotropic support to manage their ADHF. A timeline for diagnosis, treatment, reassessment, and disposition is provided and encourages an early, aggressive approach to treating patients with ADHF.ConclusionsHospitalization for ADHF is common and costly. Consensus guidelines for the treatment of ADHF did not previously exist, resulting in inconsistent and inefficient treatment. Consequently, hospitals struggling with the treatment of ADHF may find these guidelines and the process by which they were developed useful.

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