On May 21, 2015, EuropeanHeartJournal published the Guidelines for the Prehospital and In-hospital Management of Acute Heart Failure, jointly developed by the European Society of Cardiology (ESC) Committee on Heart Failure, the European Society for Emergency Care and the Society for Epidemiologic Emergency Care. This guideline is highly practical and more “grounded” in the definition of acute heart failure (AHF), early prehospital management, admission assessment, laboratory tests, device therapy, drug therapy, and in-hospital treatment. The following is a preliminary interpretation of the new guidelines. Acute heart failure (AHF) is usually defined as the first occurrence or rapid deterioration of the signs and symptoms of chronic heart failure (CHF), accompanied by elevated brain natriuretic peptide (BNP/NT-proBNP). For the first time, BNP/NT-proBNP was included in the definition. 2. The concept of “prompt treatment” should be emphasized for AHF caused by acute coronary syndrome (ACS). AHF caused by other factors should be treated as early as possible. 3. For patients with AHF in the prehospital phase, the following measures can provide early benefit. For example, non-invasive monitoring, including pulse oximetry, blood pressure, respiratory rate, and continuous electrocardiographic monitoring, should be performed early (e.g., in the ambulance); oxygen therapy should be performed promptly if oxygen saturation is <90%; non-invasive ventilation is also an early treatment measure for patients with respiratory distress; the use of vasodilators and diuretics should be decided according to the patient's blood pressure and/or degree of congestion; and the patient should be transferred as soon as possible to a large or medium-sized hospital that has a complete cardiology department and/or CCU/ICU in the vicinity. Referral to a nearby medium or large hospital with a complete cardiology department and/or CCU/ICU as soon as possible. Early natriuretic peptide testing would also be beneficial (including fingertip natriuretic peptide). Once the patient is admitted to the emergency department/CCU/ICU, both diagnosis and treatment need to be initiated immediately. 4. Improve admission clinical assessment and clinical investigation. For suspected patients, the degree of dyspnea, hemodynamic status and cardiac rhythm should be assessed in a timely manner, and the following should be recorded: (1) the severity of dyspnea, including respiratory rate, whether the patient can lie on his/her back, the strength of respiration, and the degree of hypoxia; (2) the blood pressure (diastolic and systolic); (3) the cardiac rhythm and heart rate; (4) the temperature, and whether there are any hypoperfusion signs (such as extremity queer coldness, narrowing of pulse pressure, or mental indifference). (5) Repeated assessment of the above issues will facilitate the treatment and diagnosis of AHF. (5) Focus on basic examinations, such as: electrocardiogram, laboratory tests (cTn, BNP/NT-proBNP, Cr and BUN, D-dimer, blood glucose, blood routine, etc.), bedside X-ray of chest, echocardiography, and so on. It helps to understand the etiology of the patient's condition. It was specifically highlighted that patients should have their Cr and BUN, electrolytes, and BNP/NT-proBNP reviewed every 1-2 days, with emphasis on monitoring in critically ill patients. 6, also put forward specific requirements for nursing. It is proposed that: (1) there should be a safe and suitable clinic environment; (2) objectively record the patient's therapeutic response and related symptoms and signs; (3) reasonably formulate the discharge plan or referral to the multidisciplinary disease treatment department. At the same time, we should pay attention to the psychological counseling of patients and appropriate communication with their families. Closely monitor the patient's condition and communicate with the doctor in a timely manner. 7. Specific instructions are given for oxygen therapy and assisted breathing points. (1) Use oximetry to monitor SpO2. (2) Evaluate the patient's blood pH after admission, especially for patients with acute pulmonary edema or history of COPD. (3) Consider oxygen therapy if SpO2 is <90%. Decreases in SpO2 can be detected in patients with moderate heart failure, and FiO2 can be increased to 100% as needed; adjustments are made according to SpO2. For patients with significant dyspnea, it is especially recommended that noninvasive ventilation should be used as early as possible, even during transportation, and the PS-PEEP model is recommended. 8, in order to improve the symptoms, the guideline proposes to give diuretics and vasodilators at an early stage. The start is intravenous furosemide 20mg to 40mg, and for patients with acute decompensation the starting dose is not less than the largest previous oral dose. If the patient has normal or high systolic blood pressure (SBP ≥110 mmHg), intravenous vasodilators may be given. It should also be noted that there is no clear and sufficient guidance on the optimal dose and timing of administration of intravenous diuretics. The guideline suggests that intravenous cardiac glycosides can be administered in patients with AHF combined with fast ventricular rate atrial fibrillation, and at this time, β-blockers are also the first-line recommended drugs. 9.Drugs that should be used with caution in AHF (excluding cardiogenic shock). (1) Opioids are not recommended for routine use in acute heart failure; (2) Guidelines indicate that there is no indication for the use of vasoconstrictor drugs in patients with SBP >110 mmHg; at the same time, sympathomimetic active drugs should be discontinued when low cardiac output improves and blood pressure stabilizes. 10, Current standard oral drug therapy. (1) In patients with AHF presenting with decompensated heart failure, every effort should be made to maintain oral medications that improve the patient’s prognosis and symptoms; (2) In patients with new-onset AHF, every effort should be made to initiate standard oral drug therapy after hemodynamic stabilization. In particular, β-blockers can be safely used in patients with AHF other than cardiogenic shock. 11, Emergency Room Discharge Considerations. For patients with clear etiology and repeated hospitalization in the acute decompensated portion of the hospital, they can be discharged after emergency room treatment if they meet the following conditions: (1) the patient complains of improvement in their condition; (2) resting heart rate <100bpm; (3) no standing hypotension; (4) normal urine output; (5) indoor oxygen saturation >95%; and (6) no or moderate deterioration of renal function. Highlighting that the chronic disease management program should be initiated immediately after emergency fast-track discharge. On the other hand, newly occurring AHF cannot be discharged home directly from the emergency department, and requires further etiological clarification in the intermediate wards to continue treatment, after which it can be entered into the management plan. 12. Ward and ICU/CCU treatment points. Emphasize the complexity and severity of AHF, pointing out that: (1) the patient should be placed in a place where CPR can be carried out immediately; (2) specialist nurse care and physician treatment are required; (3) high-risk patients are recommended to be admitted to the CCU for specialist treatment; (4) a green channel should be set up for patients with AHF. 13. Precautions for in-hospital monitoring. (1) Patients need to be weighed daily and have an accurate fluid balance record sheet; (2) Standard noninvasive monitoring is given, and the indicators include pulse, respiratory rate, and blood pressure; (3) Renal function and electrolytes are tested every day; (4) Detection of natriuretic peptide prior to discharge is helpful in the development of post-discharge treatment plans. (4) Detection of natriuretic peptide before discharge is helpful for the development of post-discharge treatment plan. (1) Discharge criteria: ① hemodynamic stability, normal volume, standard oral drug therapy and normal renal function 24 hours before discharge; ② have been informed of self-care related content. (2) Follow-up program: ① Enrolled in the disease management system; ② Follow-up by the attending physician within one week of discharge; ③ Chronic heart failure patients are included in the heart failure follow-up cohort. 15, cardiogenic shock diagnosis and treatment points. (1) Defined as adequate blood volume but still with hypotension (SBP <90 mmHg) and hypoperfusion as disease manifestations; (2) For patients suspected of having cardiogenic shock, electrocardiography and cardiac ultrasound should be performed immediately; (3) invasive monitoring by arterial catheterization is required; (4) the optimal modality for monitoring the hemodynamic status of patients with cardiogenic shock is inconclusive, including pulmonary artery catheterization; (5) if the patients (5) Volume supplementation is recommended as first-line therapy if the patient has no evidence of volume overload; (6) Dobutamine may be used to increase cardiac output, and levosimendan may be considered, especially in patients with chronic heart failure on oral beta-blockers; (7) Early administration of vasoactive agents, norepinephrine is preferable to dobutamine, if systolic blood pressure is difficult to maintain; (8) Prompt referral to a specialist; (9) Aortic balloon dilatation is not recommended (10) Aortic balloon dilatation is not recommended; (11) Aortic balloon dilatation is not recommended; (12) Aortic balloon dilatation is not recommended. (9) Aortic balloon dilatation is not recommended; (10) Short-term mechanical circulatory support may be considered in refractory cardiogenic shock, but the patient's age, comorbidities, and neurologic status need to be taken into account; and it is uncertain which mechanical circulation is preferable. In conclusion, this guideline provides a detailed description of the identification, diagnosis, acute treatment, nursing care, and follow-up of AHF through the above content, which is a new and effective "flowchart" for promoting the diagnosis and treatment of AHF in China and provides more effective guidance, which is worthy of our clinical reference.