Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions

•Current financial pressures, coupled with an urgent need to improve post-discharge outcomes, have provided incentives to offer treatments for acute heart failure outside of a traditional hospital setting.•This review summarizes the current state of evidence to support acute heart failure treatment in emergency departments, same-day-access clinics, and skilled nursing facilities, and provides considerations for designing treatment strategies to be implemented in alternative care settings.

The management of acute heart failure is shifting toward treatment approaches outside of a traditional hospital setting. Many heart failure providers are now treating patients in less familiar health care settings, such as acute care clinics, emergency departments, and skilled nursing facilities. In this review we describe the current pressures driving change in the delivery of acute heart failure and summarize the evidence regarding treatments for acute heart failure outside of the inpatient setting. We also provide considerations for the design of future treatment strategies to be implemented in alternative care settings.