Organ injury and impairment are commonly observed in patients with acute heart
failure (AHF), and congestion is an essential pathophysiological mechanism of impaired
organ function. Congestion is the predominant clinical profile in most patients with AHF;
a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock.
Hypoperfusion further deteriorates organ function. The injury and dysfunction of target
organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are
associated with increased risk for mortality. Improvement in organ function after
decongestive therapies has been associated with a lower risk for post-discharge mortality.
Thus, the prevention and correction of organ dysfunction represent a therapeutic target of
interest in AHF and should be evaluated in clinical trials. Treatment strategies that
specifically prevent, reduce or reverse organ dysfunction remain to be identified and
evaluated to determine if such interventions impact mortality, morbidity and
patient-centred outcomes. This paper reflects current understanding among experts of the
presentation and management of organ impairment in AHF and suggests priorities for future
research to advance the field.