What are the recommended pharmacological treatments for managing acute decompensated heart failure in primary care?

In primary care, the pharmacological treatment for managing acute decompensated heart failure primarily involves the use of intravenous diuretic therapy, which can be administered via bolus or infusion strategy to relieve congestion and fluid overload ¹.

For people already on diuretics, consider increasing the dose unless there are concerns about adherence or adverse effects, and closely monitor renal function, weight, and urine output during therapy ¹.

Do not routinely offer nitrates or sodium nitroprusside in acute heart failure; however, intravenous nitrates may be used in specific circumstances such as concomitant myocardial ischaemia, severe hypertension, or valvular regurgitation, with blood pressure closely monitored in a setting with at least level 2 care ¹.

Inotropes or vasopressors are generally not recommended unless there is potentially reversible cardiogenic shock, and should be administered in a high-dependency setting ¹.

Non-invasive ventilation is not routinely recommended but should be considered in cases of severe dyspnoea with acidaemia or as an adjunct if the condition fails to respond to medical therapy ¹.