CHALLENGES IN THE CLINICAL DIAGNOSIS OF DECOMPENSATED HEART FAILURE

Abstract

Decompensated heart failure (DHF) is a heterogeneous clinical syndrome and a leading cause of hospitalization, particularly among the elderly, associated with high morbidity and mortality and a significant impact on quality of life (Voors et al., 2022; Kamiya et al., 2025). Diagnosis remains challenging due to the variety of signs and symptoms and frequent overlap with comorbidities such as frailty and sarcopenia. Contemporary assessment integrates clinical manifestations, natriuretic peptide measurement, echocardiography, and lung ultrasound, highlighting the identification of B-lines as a marker of congestion. Artificial intelligence tools and the HFA-PEFF algorithm aid in diagnostic accuracy, particularly in heart failure with preserved ejection fraction (HFpEF). Following stabilization, the early introduction of prognostic-modifying therapies—such as empagliflozin and sacubitril/valsartan—combined with cardiovascular rehabilitation programs initiated during the hospital stay, is crucial for functional recovery and the reduction of readmissions. In conclusion, the management of DHF requires a multidimensional and integrated approach that considers the specific clinical and individual characteristics of each patient.