Special topics: heart failure-related cardiogenic shock, valvular heart disease and end-stage renal disease. Part 4 of the International Expert Opinion Series on Acute Heart Failure Management.

Acute heart failure (AHF) remains a major global health challenge, contributing significantly to morbidity, mortality, and healthcare resource utilization. Among its clinical phenotypes, heart failure-related cardiogenic shock (HF-CS) represents a particularly severe and complex presentation that differs from acute myocardial infarction-related cardiogenic shock in terms of clinical characteristics, haemodynamic profiles, therapeutic response, and outcomes. In a subset of patients, AHF is related to or coexists with valvular heart diseases (VHDs) that require specific management strategies and treatments, namely aortic stenosis, mitral stenosis, aortic regurgitation, and mitral regurgitation. Another challenging scenario is represented by AHF in patients with end-stage renal disease (ESRD), since the risk of adverse outcomes is particularly high, conventional diuretic strategies cannot be pursued, and renal replacement therapy is frequently required. In this state-of-the-art review (part 4 of the International Expert Opinion Series on AHF Management), we propose a pragmatic, evidence-based framework for managing AHF complicated by HF-CS, VHDs, or ESRD.