Using the Emergency Department Clinical Decision Unit for Acute Decompensated Heart Failure

Peacock, W. Frank

doi:10.1016/j.ccl.2005.08.014

Cited by 25 publications

(14 citation statements)

References 84 publications

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“…In a study by Atlas et al , providing physicians with the pneumonia severity index score increased the proportion of patients with pneumonia treated as outpatients from 42% to 52% 16. Reports show that the application of disease management protocols or guidelines was effective in reducing admissions for bronchial asthma,17 heart failure,6 18 pneumonia19 and chest pain 20…”

Section: Discussionmentioning

confidence: 99%

Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit

Gonnah

Hegazi²,

Hmdy³

et al. 2008

Emergency Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit

Gonnah

Hegazi²,

Hmdy³

et al. 2008

Emergency Medicine Journal

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“…[4] Due to poor short-term cardiovascular outcomes, [5] the majority (about 80%) of AHF patients are hospitalized. [6] In this setting, the ED physician may play an important role, not only for clinical and haemodynamic stabilization, but also for intra-hospital management and outcomes of these patients. [7] In about 50% of patients with AHF, the main haemodynamic impairment is primarily characterized by left ventricular (LV) systolic dysfunction, low cardiac output and fluid overload.…”

Section: Introductionmentioning

confidence: 99%

B-Type Natriuretic Peptide and Non-Invasive Haemodynamics and Hydration Status Assessments in the Management of Patients with Acute Heart Failure in the Emergency Department

Marino

Magrini

Ferri

et al. 2010

High Blood Pressure & Cardiovascular Prevention

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Introduction: An impairment of cardiac haemodynamics and fluid retention may occur in patients with acute heart failure (AHF) because of left ventricular (LV) dysfunction due to volume and or pressure overload. The measurement of B-type natriuretic peptide (BNP) represents the 'gold standard' of biomarker assessment for evaluating LV adaptations to AHF. More recently, Nexfin and bioelectric impedance vector analysis (BIVA) techniques have been proposed for non-invasively assessing haemodynamic and hydration status, respectively. These techniques are rapidly and easily executable and, most importantly, may be repeated over time. Aim: To validate the applicability of Nexfin and BIVA techniques, in association with BNP dosage, and changes of these parameters after treatment during hospitalization in patients with AHF referring to the emergency department (ED). Methods: We enrolled 44 patients (20 female, mean age 77 -7.7 years), referring to ED for AHF. During hospitalization (mean -SD: 4.12 -1.45 days), all patients underwent BNP measurements at admission, 24 hours, 72 hours and at discharge. At the same time intervals, Nexfin and BIVA were also performed. According to international guidelines, all patients were treated with optimal pharmacological therapy, independently of other parameters examined during hospitalization. Results: Compared with baseline (747.61 -658.54 pg mL), we observed a statistically significant reduction of BNP levels at 72 hours (357.64 -193.81 pg mL; p < 0.05) and at discharge times (248.57 -194.46 pg mL; p < 0.05). In addition, a significant reduction of hydration status, evaluated through BIVA, was observed at discharge compared with hospital admission (from 79.44 -6.47% to 76.35 -5.5%; p < 0.05). This was paralleled at Nexfin evaluation by a significant increase of cardiac index (from 2.32 -0.95 to 3.9 -1.18 L min m 2 ) and clinical improvement of New York Heart Association class at discharge compared with hospital admission. Finally, we observed a statistically significant correlation between percentage variation of cardiac index and hydration status from admission to discharge (p < 0.05). Conclusions: In patients with AHF, admitted to ED, simultaneous monitoring of cardiac index and of hydration status by non-invasive methods may be useful for confirming clinical diagnosis, beyond dosages of BNP. These techniques could also be useful for intra-hospital management of AHF patients. In fact, their variations, coupled with the BNP ones, during hospitalization, may be of value in order to easily and rapidly identify clinical and haemodynamic improvements of AHF, which may be of key relevance for appropriate discharges from EDs.

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“…These may include ischemia, hypotension or hypertension, arrhythmias, valvular heart disease, worsening renal function, uncontrolled diabetes, or infectious etiologies, as well as medication and dietary nonadherence. Diagnostic procedures may be necessary to assess the progression of disease or determine the precipitant cause of the AHFS [10]. However, the more numerous and complex the diagnostics become, the more likely the patient will require an inpatient evaluation.…”

Section: Heart Failure Managementmentioning

confidence: 98%

“…A protocolized approach to the treatment of AHFS is a common theme in all successful AHFS OU programs [10]. Treatment algorithms can be divided into four subgroups: monitoring/nursing care, medical therapy, diagnostic procedures, and educational/social services.…”

Section: Heart Failure Managementmentioning

confidence: 99%

“…A 2002 report describes that use of an AHFS OU protocol results in a 56% reduction in 90-day HF ED revisit rate (P<0.0001) and a 64% reduction in 90-day HF readmission to hospital (P=0.007). The 90-day mortality rate was reduced from 4% to 1% (P=0.096) [10]. Another study suggests that severity and number of complications from AHFS can be reduced with a detailed treatment protocol that delivers timely evidence-based therapies in the OU setting [11].…”

Section: Introductionmentioning

confidence: 99%

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Observation Units in the Management of Acute Heart Failure Syndromes

Fermann

Collins

2010

Curr Heart Fail Rep

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Observation units (OUs) for acute heart failure syndromes (AHFS) have proven to be effective in reducing heart failure admissions and may reduce costs. Goals for risk-stratifying patients with AHFS in OUs include determining patients suitable for OU management and determining end points of treatment. Although many provider models and settings exist, management algorithms common to most OUs include monitoring/nursing care, diagnostic procedures, therapy, and educational/social services. The focus of OU management involves an assessment of the factors that led to the decompensation and identification of the predominant clinical features such as hypertension and congestion. Acute therapy still leans heavily on symptom relief with diuretics and nitroglycerin. For newly diagnosed patients, initiation of guideline-recommended therapies like angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers is an integral part of OU protocols. Patient education and coordination of outpatient care continues to be paramount in preventing early readmission in this patient population.

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Using the Emergency Department Clinical Decision Unit for Acute Decompensated Heart Failure

Cited by 25 publications

References 84 publications

Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit

Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit

B-Type Natriuretic Peptide and Non-Invasive Haemodynamics and Hydration Status Assessments in the Management of Patients with Acute Heart Failure in the Emergency Department

Observation Units in the Management of Acute Heart Failure Syndromes

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