The BRONCH‐AHF study: effects on short‐term outcome of nebulized bronchodilators in emergency department patients diagnosed with acute heart failure

Miró, Òscar; Gil, Víctor; Martín‐Sánchez, Francisco Javier; Llorens, Pere; Herrero, Pablo; Mebazaa, Alexandre; Harjola, Veli‐Pekka; Ríos, José; Marco-Hernández, Javier; Collins, Sean P.; Peacock, W. Frank; Hollander, Judd E.; Lorca, María Teresa; Jacob, Javier

doi:10.1002/ejhf.1028

Cited by 9 publications

(3 citation statements)

References 5 publications

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“…74,75 Morphine (boluses of 2-4 mg) is the most used single drug in this setting, 72 although recent data raised safety concern of its use in AHF. 77 Other opioids, propofol, midazolam, and more recently dexmedetomidine, which is an a2-adrenergic receptor agonist with less central respiratory depression, have been used in this context. 75,76 Starting non-invasive ventilation Before starting the technique, the contraindications for NIV should be considered (Table 4).…”

Section: Complementsmentioning

confidence: 99%

Indications and practical approach to non-invasive ventilation in acute heart failure

Masip

Peacock

Price

et al. 2017

European Heart Journal

139

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In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.

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Section: Complementsmentioning

confidence: 99%

Indications and practical approach to non-invasive ventilation in acute heart failure

Masip

Peacock

Price

et al. 2017

European Heart Journal

139

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“…She was nebulised with formoterol and budesonide during her initial presentation to provide her with some symptomatic relief. Although bronchodilator is not a part of the management of heart failure, they can be used to provide symptomatic relief, especially in an emergency room 5. After establishing a diagnosis of MM, her cytogenetic panel FISH was done which was negative for prognostically significant abnormalities.…”

Section: Treatmentmentioning

confidence: 99%

An interesting case of AL amyloidosis and MM: a complex scenario with cardiac involvement

Gaba,

Kumar,

Pandey

et al. 2024

BMJ Case Rep

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Our patient presented with complaints of progressive shortness of breath for 1 month. She was diagnosed with a case of infiltrative type of restrictive cardiomyopathy (RCM) based on echocardiography and cardiac MRI findings. Her fat pad biopsy was suggestive of AL type of amyloidosis (AL). She was diagnosed with a case of multiple myeloma (MM) based on bone marrow biopsy findings with 48% plasma cells and a skeletal survey with lytic bone lesions on the skull, thus meeting the Crab criteria. We want to highlight the complex nature of this case and the difficulties associated with making a diagnosis. This case report presents an excellent opportunity to touch on the interesting topics of RCM, amyloidosis and MM.

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“…This approach may involve the administration of medications not specifically indicated for the underlying cause of dyspnoea. For instance, studies have shown that approximately 18 % of dyspnoea patients ultimately prognosed with acute heart failure were treated using bronchodilators, while 14 % of AHF patients receive corticosteroids [17,18]. In our stratified analysis, no subgroup exhibited a significant association with either worse or improved outcomes.…”

Section: Discussionmentioning

confidence: 71%

Safety of Diuretic Administration in Early Dyspnea Patients Not Finally Diagnosed With Acute Heart Failure: A Clinical Study.

Chhotaray

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The study aims to investigate the effect of initiating diuretic treatment in dyspnea patients without a confirmed diagnosis of acute heart failure, assessing its connection with immediate medical outcomes, mortality, and readmission rates.Additionally, the study explores potential variations in treatment effects across subgroups and provides insights into the implications of diuretic administration in the emergency department. MethodsThis study, conducted at Bhima Bhoi Medical College in Balangir, Odisha, India, employed exploratory secondary analysis of BASEL-V registry data, examining 266 dyspnoeic patients diagnosed with conditions other than AHF. The analysis assessed outcomes, categorizing patients into treated and untreated groups, with statistical methods including Wilcoxon rank-sum, chi-square tests, and t-test. ResultsOut of 533 initial patients from the BASEL-V registry, 266 were analysed, with 14.6% receiving diuretics during their ED stay. The 30-day mortality rate was 4.5%, with a 5.2% mortality rate in treated patients and 4.3% in untreated patients, resulting in a non-significant adjusted hazard ratio of 1.33 for treated patients. For the secondary outcome, 13.9% experienced readmission within 30 days, with a 14.7% rate for treated patients and 10.8% for untreated patients. ConclusionThe study revealed that diuretic administration in dyspnoeic patients without acute heart failure had not significantly impacted on the readmission or mortality rates. While an increased hazard ratio for thirty-day mortality was observed in treated patients, it was not statistically significant, suggesting a need for cautious interpretation and further research validation. RecommendationThe study recommends further research to validate and refine findings, emphasizing a larger sample size. Additionally, exploration of specific subgroups, such as those with COPD, and a comprehensive investigation into the impact of diuretic administration on elderly patients are advised for a more nuanced understanding of therapeutic implications.

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The BRONCH‐AHF study: effects on short‐term outcome of nebulized bronchodilators in emergency department patients diagnosed with acute heart failure

Cited by 9 publications

References 5 publications

Indications and practical approach to non-invasive ventilation in acute heart failure

Indications and practical approach to non-invasive ventilation in acute heart failure

An interesting case of AL amyloidosis and MM: a complex scenario with cardiac involvement

Safety of Diuretic Administration in Early Dyspnea Patients Not Finally Diagnosed With Acute Heart Failure: A Clinical Study.

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