Recommendation 130: We suggest the use of a validated diagnostic scoring system for patients in whom the diagnosis of AHF is being considered (Weak Recommendation, Low Quality Evidence).

Recommendation 131: We recommend the diagnosis of acute heart failure be established within < 2 hours of the initial contact in the emergency department (Strong Recommendation, Low Quality Evidence).

Values and preferences: This recommendation places a relatively high value on evaluating the constellation of clinical findings in a patient with suspected AHF and less value on an individual physical examination finding, presenting symptom, or investigation.

• A precipitating cause for AHF should be sought.
• An ECG, blood tests and a chest x-ray should be performed within 2 hours of initial presentation.
• Initial blood tests should include: complete blood count, creatinine, blood urea nitrogen, glucose, sodium, potassium, troponin.
• A transthoracic echocardiogram should be performed within 72 hours of presentation. For patients with a previous echocardiogram, another is not required unless there has been a significant change in clinical status requiring investigation, a lack of clinical response to appropriate therapy, and/or it is greater than 12 months since the previous echocardiogram.