scholarly journals Effects on short term outcome of non-invasive ventilation use in the emergency department to treat patients with acute heart failure: A propensity score-based analysis of the EAHFE Registry

2018 ◽  
Vol 53 ◽  
pp. 45-51 ◽  
Author(s):  
Òscar Miró ◽  
Gemma Martínez ◽  
Josep Masip ◽  
Víctor Gil ◽  
Francisco Javier Martín-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Propensity Score ◽  
Acute Heart Failure ◽  
Invasive Ventilation ◽  
Short Term ◽  
Term Outcome ◽  
Non Invasive ◽  
Short Term Outcome ◽  
Non Invasive Ventilation

scholarly journals PL01: Creation of a risk scoring system for emergency department patients with acute heart failure

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S5-S5
Author(s):  
I. Stiell ◽  
J. Perry ◽  
C. Clement ◽  
S. Sibley ◽  
A. McRae ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients ◽  
Risk Scoring ◽  
Risk Scale

Introduction: Acute heart failure (AHF) is a common emergency department (ED) presentation and may be associated with poor outcomes. Conversely, many patients rapidly improve with ED treatment and may not need hospital admission. Because there is little evidence to guide disposition decisions by ED and admitting physicians, we sought to create a risk score for predicting short-term serious outcomes (SSO) in patients with AHF. Methods: We conducted prospective cohort studies at 9 tertiary care hospital EDs from 2007 to 2019, and enrolled adult patients who required treatment for AHF. Each patient was assessed for standardized real-time clinical and laboratory variables, as well as for SSO (defined as death within 30 days or intubation, non-invasive ventilation (NIV), myocardial infarction, coronary bypass surgery, or new hemodialysis after admission). The fully pre-specified, logistic regression model with 13 predictors (age, pCO2, and SaO2 were modeled using spline functions with 3 knots and heart rate and creatinine with 5 knots) was fitted to the 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions and estimated a sample size of 170 SSOs. Results: The 2,246 patients had mean age 77.4 years, male sex 54.5%, EMS arrival 41.1%, IV NTG 3.1%, ED NIV 5.2%, admission on initial visit 48.6%. Overall there were 174 (7.8%) SSOs including 70 deaths (3.1%). The final risk scale is comprised of five variables (points) and had c-statistic of 0.76 (95% CI: 0.73-0.80): 1.Valvular heart disease (1) 2.ED non-invasive ventilation (2) 3.Creatinine 150-300 (1) ≥300 (2) 4.Troponin 2x-4x URL (1) ≥5x URL (2) 5.Walk test failed (2) The probability of SSO ranged from 2.0% for a total score of 0 to 90.2% for a score of 10, showing good calibration. The model was stable over 1,000 bootstrap samples. Choosing a risk model total point admission threshold of >2 would yield a sensitivity of 80.5% (95% CI 73.9-86.1) for SSO with no change in admissions from current practice (48.6% vs 48.7%). Conclusion: Using a large prospectively collected dataset, we created a concise and sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of this risk scoring scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

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

2017 ◽  
Vol 20 (4) ◽  
pp. 822-826 ◽  
Author(s):  
Òscar Miró ◽  
Josep Tost ◽  
Víctor Gil ◽  
Francisco Javier Martín-Sánchez ◽  
Pere Llorens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Emergency Department Patients

scholarly journals LO02: Development of the HEARTRISK6 Scale for emergency department patients with acute heart failure

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S7
Author(s):  
I. Stiell ◽  
A. McRae ◽  
B. Rowe ◽  
J. Dreyer ◽  
L. Mielniczuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Tertiary Care ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients ◽  
Risk Scale

Introduction: We previously derived (N = 559) and validated (N = 1,100) the 10-item Ottawa Heart Failure Risk Scale (OHFRS), to assist with disposition decisions for patients with acute heart failure (AHF) in the emergency department (ED). In the current study we sought to use a larger dataset to develop a more concise and more accurate risk scale. Methods: We analyzed data from the prior two studies and from a new cohort. For all 3 groups we conducted prospective cohort studies that enrolled patients who required treatment for AHF at 8 tertiary care hospital EDs. Patients were followed for 30 days. The primary outcome was short-term serious outcome (SSO), defined as death within 30 days, intubation or non-invasive ventilation (NIV) after admission, myocardial infarction, or relapse resulting in hospital admission within 14 days. The fully pre-specified logistic regression model with 13 predictors (where age, pCO2, and SaO2 were modeled using spline functions) was fitted to 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions, and estimated a sample size of 2,000 patients. Results: The 1,986 patients had mean age 77.3 years, male 54.1%, EMS arrival 41.2%, IV NTG 3.3%, ED NIV 5.4%, admission on initial visit 49.5%. Overall there were 236 (11.9%) SSOs including 61 deaths (3.1%), meaning that current admission practice sensitivity for SSO was only 59.7%. The final HEARTRISK6 scale is comprised of 6 variables (points) (C-statistic 0.68): Valvular heart disease (2) Antiarrhythmic medication (2) ED non-invasive ventilation (3) Creatinine 80–150 (1); ≥150 (3) Troponin ≥3x URL (2) Walk test failed (1). The probability of SSO ranged from 4.8% for a total score of 0 to 62.4% for a score of 10, showing good calibration. Choosing a HEARTRISK6 total point admission threshold of ≥3 would yield sensitivity of 70.8% (95%CI 64.5-76.5) for SSO with a slight decrease in admissions to 47.9%. Choosing a threshold of ≥2 would yield a sensitivity of 84.3% (95%CI 79.0-88.7) but require 66.6% admissions. Conclusion: Using a large prospectively collected dataset, we created a more concise and more sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of the HEARTRISK6 scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

scholarly journals The Association Between Early Administration of Noninvasive Ventilation and Short-Term Outcome for Acute Heart Failure

Cureus ◽  
2021 ◽  
Author(s):  
Taichi Nakazawa ◽  
Hiraku Funakoshi ◽  
Chinami Sakurai ◽  
Koki Iwata ◽  
Satsuki Yamazaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Noninvasive Ventilation ◽  
Short Term ◽  
Early Administration ◽  
Term Outcome ◽  
Short Term Outcome

Hemodynamic variables (cardiac power) and their changes during 6 hours are the strongest predictors of short-term outcome in acute heart failure

2004 ◽  
Vol 10 (4) ◽  
pp. S31
Author(s):  
Guillermo Torre-Amione ◽  
Olga Milo ◽  
Edo Kaluski ◽  
Aline Frey ◽  
Loic Perchenet ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Short Term ◽  
Term Outcome ◽  
Cardiac Power ◽  
Hemodynamic Variables ◽  
Short Term Outcome

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

2017 ◽  
Vol 39 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Josep Masip ◽  
W Frank Peacock ◽  
Susanna Price ◽  
Louise Cullen ◽  
F Javier Martin-Sanchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Practical Approach ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Non-invasive ventilation in acute heart failure

2020 ◽  
Vol 72 ◽  
pp. S23-S24
Author(s):  
Sarda Mukund Shyam ◽  
Darshan Mehra ◽  
R.R. Chaudhary
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation
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