People with acute heart failure have a higher risk of death than those who suffer a heart attack, yet heart failure care lags 30 years behind, experts have insisted.

Heart failure is a potentially life-threatening condition which leads to the heart being unable to pump enough blood around the body. Symptoms include tiredness, shortness of breath, dizziness and swollen ankles and around 10,000 new cases are diagnosed in Ireland every year.

Heart failure can be chronic, which means it happens slowly over time, or acute, which means it can happen suddenly.

The first European advice on emergency care for patients with acute heart failure has just been published in the European Heart Journal and it notes that just half of patients who are discharged from hospital with acute heart failure will still be alive three years later.

"Mortality from acute heart failure is even higher than from a heart attack so it is an urgent situation. Only half of patients discharged from hospital with acute heart failure are alive in three years, even though they felt fine," explained Prof Christian Mueller, chair of the Acute Heart Failure Study Group within the European Society of Cardiology (ESC).

However, he emphasised that despite the seriousness of this condition, ‘there are no standard treatment pathways, whereas these were agreed across Europe for heart attack 30 years ago'.

"The paper published is the first step towards catching up with heart attack care and establishing similar standards for acute heart failure," he commented.

Prof Mueller explained that most patients with acute heart failure ‘cannot be cured', however symptoms such as severe shortness of breath (dyspnoea) can be treated effectively.

"But the underlying progressive disease remains and patients need long-term follow up to make sure they are on the correct medication at the right dosages," he said.

The paper published in the European Heart Journal focuses on the decision of whether to discharge patients with acute heart failure from Emergency Departments and see them as outpatients, or admit them as inpatients.

There has been no guidance on this issue until now, resulting in many patients being admitted to hospital even if this was not the best environment for them.

"The hospital is not always the best place to care for acutely ill patients. While in hospital, patients with acute heart failure - who are 78 years old on average - are at risk of developing infections and they have problems sleeping. There is also pressure on hospitals to avoid expensive admissions when possible. But patients do benefit from more intense follow up while in hospital," Prof Mueller noted.

The paper provides criteria to help doctors choose which patients can be discharged safely from the ED. However, the importance of long-term follow up is emphasised regardless of whether patients are discharged or admitted to hospital. This follow up should be done by the ED team in collaboration with the patient's GP, cardiologist and anyone else involved in their care.

"It's never ever possible to treat acute heart failure sufficiently in 24 hours in the ED. Intense follow up will always be needed. It's the task of the ED physician to either make the first follow-up appointment or to ensure that this will occur.

"Patients should be seen by their GP within 48 hours to fine tune the number of drugs and their doses, and assess vital signs, blood pressure, electrolytes and kidney function," Prof Mueller said.

He added that ultimately, it is hoped that this guidance ‘will improve the management of patients with acute heart failure and make some inroads towards giving them a better outlook'.

The guidance is published in the European Heart Journal: Acute Cardiovascular Care.