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7.4.1 Phase 1 (initial management)
The primary objectives in phase 1 are reported in Figure 12. In many cases, this phase starts in pre-hospital settings. Pre-hospital management should not delay the rapid transfer of the patient to the most appropriate medical setting, where further work-up is undertaken. Patients should be triaged based on their haemodynamic and clinical status to determine the appropriate level of care and monitoring requirements. For patient risk stratification, specific scores have been proposed, but they need further validation (see Supplementary data online, Section S4.2.1).486,487 In patients with suspicion of CS and with a potential indication for temporary MCS, consultation with the Shock Team is recommended (see Section 7.5.11).488 In these patients, as well as in those with other life-threatening conditions, the diagnostic work-up and appropriate rescue pharmacological and nonpharmacological treatment should be initiated promptly and simultaneously (Figure 13). Identification and possible treatment of acute causes is crucial.118,119,489–491 Combination and timing of different treatments depend on clinical presentation (Figure 13). In patients already receiving FMT, continuation and/or rapid reintroduction as soon as possible is recommended. Discontinuation of FMT is not recommended unless there are clear signs of hypoperfusion or specific clinical indications. Monitoring during and after initial stabilization is mandatory (see Supplementary data online, Table S12).
7.4.2 Phase 2 (stabilization)
The primary objective of this phase is to maintain and enhance the patient’s haemodynamic status and, once the patient is
Figure 12 Phases and goals for in-hospital management of decompensated heart failure. AMT, additional medical therapy; FMT, foundational medical therapy; GDIT, guideline-directed interventional therapy; HF, heart failure. aSee Figure 14. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026
