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Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients older than 65 years. It continues to increase in prevalence and is associated with significant mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than 8 million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The definition of ADHF has important limitations, and its management differs significantly from that of chronic heart failure. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that more studies began to address the management of ADHF. The mainstay of ADHF management involves identification of precipitating factors, oxygen supplementation, sodium and fluid restriction, and diuresis. The phenomenon of diuretic resistance is a significant obstacle to relief of congestion and is a field of active investigation. Other important adjuncts to treatment include noninvasive ventilation, inotropes, vasopressors, nitrates, opiates, and vasopressin receptor antagonists. In this review, we will discuss the terminology and classification of ADHF, and review the multiple modalities and strategies available for the management of this disorder. Keywords: heart failure, medical management, complications, devices, palliative care

Acute decompensated heart failure is a clinical syndrome involving the congestion of vital organs, such as the kidneys, liver, and brain, leading to loss of autoregulation and multiorgan failure. The interaction between organ systems is bi-directional and complex; it cannot be explained by hypoperfusion alone. Despite the multiple signs and symptoms that arise with systemic congestion, there are limitations in the assessment of volume status based only on clinical evaluation. Invasive hemodynamic monitoring is an adjunctive diagnostic and prognostic tool in acute decompensated heart failure when standard therapy fails and/or leads to worsening renal function as well as for the evaluation of advanced therapy options. This review will discuss the use of temporary mechanical circulatory support devices in cardiogenic shock and the expected outcomes for advanced heart failure with the implementation of left ventricular assist devices and cardiac transplantation.