The HF-ABCDE + FG approach in heart failure: a simplified decision-making algorithm for management in emergency department.

Abstract The–HF– ABCDE+FG protocol is an easy to memorize algorithm for diagnosis and treatment of Heart failure (HF) in the setting of Emergency Department (ED). The acronym “ABCDE” recalls the more famous ABCDE sequence proposed in Advanced Life Support (ALS), the most widely used and standardized approach to critical patients in the ED. Using a similar approach, the algorithm here proposed can help to recall the main elements of the patient’s assessment presenting acute heart failure (AHF) concerning diagnosis and early therapy. It should be interpreted as a continuum since each step is partially overlapped and mnemonically linked to the previous and to the next one. As Acute heart failure can present with a variable pattern of signs and symptoms, diagnosis in the Emergency Department can be supported by a rapid and easy to memorize pathway made up of 5 steps: A (history assessment), B (blood exams/ blood gas analysis), C (Chest X–Ray), D (Dysfunction– lung anch heart ultrasound), E (Electricity– verify ICD or PM when implanted). On the other hand, with reference to the therapeutic algorithm, we suggest an extended protocol ABCDE+FG: each word of the acronym stands for a Class I recommendation coming from 2021 ESC Guidelines: A (ACE–i/ ARBs/ARNI), B (standing for Beta–Blockers), C (anti–choagulation) and D (Diuretics) which represent the standard desease–controlling therapy. In addiction, attention must be paid to associated conditions, like underlying electrical instability requiring PM or ICD (E standing for Electrical Therapy), iron deficiency (F standing for Ferric Carboxymaltose) and poor glycemic control (G standing for Glyfozines). In fact, it has been demonstrated that an optimyzed therapy from a very early stage can deeply impact on the evolution of desease and remarkably reduce further accesses for AHF. Thus, once the patient has been stabilyzed in the ED, we suggest to initiate the most appropriate therapy as soon as possible and eventually send the patient to the best setting of care (discharge, short observation, non intensive/intensive care).