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Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey

BACKGROUND: An appropriate diagnostic process is crucial for managing patients with acute heart failure (AHF) in emergency department (ED). Our study aims to describe the characteristics and therapeutic management of patients admitted to the ED for dyspnea suspected to have AHF, their in-hospital pa...

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Autores principales: Chouihed, Tahar, Manzo-Silberman, Stéphane, Peschanski, Nicolas, Charpentier, Sandrine, Elbaz, Meyer, Savary, Dominique, Bonnefoy-Cudraz, Eric, Laribi, Said, Henry, Patrick, Girerd, Nicolas, Zannad, Faiez, El Khoury, Carlos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026775/
https://www.ncbi.nlm.nih.gov/pubmed/27639971
http://dx.doi.org/10.1186/s13049-016-0300-x
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author Chouihed, Tahar
Manzo-Silberman, Stéphane
Peschanski, Nicolas
Charpentier, Sandrine
Elbaz, Meyer
Savary, Dominique
Bonnefoy-Cudraz, Eric
Laribi, Said
Henry, Patrick
Girerd, Nicolas
Zannad, Faiez
El Khoury, Carlos
author_facet Chouihed, Tahar
Manzo-Silberman, Stéphane
Peschanski, Nicolas
Charpentier, Sandrine
Elbaz, Meyer
Savary, Dominique
Bonnefoy-Cudraz, Eric
Laribi, Said
Henry, Patrick
Girerd, Nicolas
Zannad, Faiez
El Khoury, Carlos
author_sort Chouihed, Tahar
collection PubMed
description BACKGROUND: An appropriate diagnostic process is crucial for managing patients with acute heart failure (AHF) in emergency department (ED). Our study aims to describe the characteristics and therapeutic management of patients admitted to the ED for dyspnea suspected to have AHF, their in-hospital pathway of care and their in-hospital outcome. METHODS: Consecutive patients admitted in 26 French ED for dyspnea suspected to be the consequence of AHF, prior to in hospital diagnostic test, were prospectively included at the time of their admission in the DeFSSICA Survey. Clinical characteristics at admission were recorded by the ED physicians. At discharge from ED, patients were categorized as AHF or non-AHF based on the final diagnosis reported in the discharge summary. The completeness of the data was controlled by the local investigator. RESULTS: From 16/6/2014 to 7/7/2014, 699 patients were included, of whom 537 (77 %) had a final diagnosis of AHF at discharge. Patients with AHF were older (median 83 vs 79 years, p = 0.0007), more likely to have hypertension (71 % vs 57 %, p = 0.002), chronic HF (54 % vs 37 %, p = 0.0004), atrial fibrillation (45 % vs 34 %, p = 0.02) and history of hospitalization for AHF in the previous year (40 % vs 18 %, p < 0.0001) when compared to patients without AHF. Furosemide and oxygen were used in approximately 2/3 of the patients in the ED (respectively 75 and 68 %) whereas nitrates were in 19 % of the patients. Diagnostic methods used to confirm AHF included biochemistry (100 %), pro-B-type natriuretic peptide (90 %), electrocardiography (98 %), chest X-ray (94 %), and echography (15 %) which only 18 % of lung ultrasound. After the ED visit, 13 % of AHF patients were transferred to the intensive care unit, 28 % in cardiology units and 12 % in geriatric units. In-hospital mortality was lower in AHF vs non-AHF patients (5.6 % vs 14 %, p = 0.003). DISCUSSION: DeFSSICA, a large French observational survey of acute HF, provides information on HF presentation and the French pathway of care. Patients in DeFSSICA were elderly, with a median age of 83 years. Compared with the French OFICA study, patients in DeFSSICA were more likely to have hypertension (71 % vs 62 %) and atrial fibrillation (45 % vs 38 %). As atrial fibrillation and a rapid heart rate have been closely linked to mortality, detection of atrial fibrillation should be considered systematically.The limited use of nitrates in DeFSSICA may be related to the median SBP of 140 (121–160) mmHg. However, our use of nitrates was similar to those in the EAHFE (20.7 %) and OPTIMIZE-HF (14.3 %) registries. In line with guidelines, the proportions of patients who underwent ECG, biological analysis, or chest X-ray were all >90 % in DeFSSICA. Similarly, BNP or pro-BNP was measured in 93 % of patients, compared with 82 % of patients in the OFICA study. Although BNP may be helpful when the diagnosis of HF is in doubt, ultrasound remains the gold standard. The use of ultrasound in the ED has been reported to accelerate the diagnosis of HF and the initiation of treatment, and shorten the length of stay. In-hospital mortality of HF patients in DeFSSICA was 6.4 %, slightly lower than in the OFICA study (8.2 %). Improved interdisciplinary cooperation has been highlighted as a key factor for the improvement of HF patient care. CONCLUSIONS: DeFSSICA shows that patients admitted for dyspnea suspected to be the consequence of AHF are mostly elderly. The diagnosis of AHF is difficult to ascertain based on clinical presentation in patients with dyspnea. Novel diagnostic techniques such as thoracic ultrasound are warranted to provide the right treatment to the right patients in the ED as early as possible. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13049-016-0300-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-50267752016-09-22 Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey Chouihed, Tahar Manzo-Silberman, Stéphane Peschanski, Nicolas Charpentier, Sandrine Elbaz, Meyer Savary, Dominique Bonnefoy-Cudraz, Eric Laribi, Said Henry, Patrick Girerd, Nicolas Zannad, Faiez El Khoury, Carlos Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: An appropriate diagnostic process is crucial for managing patients with acute heart failure (AHF) in emergency department (ED). Our study aims to describe the characteristics and therapeutic management of patients admitted to the ED for dyspnea suspected to have AHF, their in-hospital pathway of care and their in-hospital outcome. METHODS: Consecutive patients admitted in 26 French ED for dyspnea suspected to be the consequence of AHF, prior to in hospital diagnostic test, were prospectively included at the time of their admission in the DeFSSICA Survey. Clinical characteristics at admission were recorded by the ED physicians. At discharge from ED, patients were categorized as AHF or non-AHF based on the final diagnosis reported in the discharge summary. The completeness of the data was controlled by the local investigator. RESULTS: From 16/6/2014 to 7/7/2014, 699 patients were included, of whom 537 (77 %) had a final diagnosis of AHF at discharge. Patients with AHF were older (median 83 vs 79 years, p = 0.0007), more likely to have hypertension (71 % vs 57 %, p = 0.002), chronic HF (54 % vs 37 %, p = 0.0004), atrial fibrillation (45 % vs 34 %, p = 0.02) and history of hospitalization for AHF in the previous year (40 % vs 18 %, p < 0.0001) when compared to patients without AHF. Furosemide and oxygen were used in approximately 2/3 of the patients in the ED (respectively 75 and 68 %) whereas nitrates were in 19 % of the patients. Diagnostic methods used to confirm AHF included biochemistry (100 %), pro-B-type natriuretic peptide (90 %), electrocardiography (98 %), chest X-ray (94 %), and echography (15 %) which only 18 % of lung ultrasound. After the ED visit, 13 % of AHF patients were transferred to the intensive care unit, 28 % in cardiology units and 12 % in geriatric units. In-hospital mortality was lower in AHF vs non-AHF patients (5.6 % vs 14 %, p = 0.003). DISCUSSION: DeFSSICA, a large French observational survey of acute HF, provides information on HF presentation and the French pathway of care. Patients in DeFSSICA were elderly, with a median age of 83 years. Compared with the French OFICA study, patients in DeFSSICA were more likely to have hypertension (71 % vs 62 %) and atrial fibrillation (45 % vs 38 %). As atrial fibrillation and a rapid heart rate have been closely linked to mortality, detection of atrial fibrillation should be considered systematically.The limited use of nitrates in DeFSSICA may be related to the median SBP of 140 (121–160) mmHg. However, our use of nitrates was similar to those in the EAHFE (20.7 %) and OPTIMIZE-HF (14.3 %) registries. In line with guidelines, the proportions of patients who underwent ECG, biological analysis, or chest X-ray were all >90 % in DeFSSICA. Similarly, BNP or pro-BNP was measured in 93 % of patients, compared with 82 % of patients in the OFICA study. Although BNP may be helpful when the diagnosis of HF is in doubt, ultrasound remains the gold standard. The use of ultrasound in the ED has been reported to accelerate the diagnosis of HF and the initiation of treatment, and shorten the length of stay. In-hospital mortality of HF patients in DeFSSICA was 6.4 %, slightly lower than in the OFICA study (8.2 %). Improved interdisciplinary cooperation has been highlighted as a key factor for the improvement of HF patient care. CONCLUSIONS: DeFSSICA shows that patients admitted for dyspnea suspected to be the consequence of AHF are mostly elderly. The diagnosis of AHF is difficult to ascertain based on clinical presentation in patients with dyspnea. Novel diagnostic techniques such as thoracic ultrasound are warranted to provide the right treatment to the right patients in the ED as early as possible. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13049-016-0300-x) contains supplementary material, which is available to authorized users. BioMed Central 2016-09-17 /pmc/articles/PMC5026775/ /pubmed/27639971 http://dx.doi.org/10.1186/s13049-016-0300-x Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research
Chouihed, Tahar
Manzo-Silberman, Stéphane
Peschanski, Nicolas
Charpentier, Sandrine
Elbaz, Meyer
Savary, Dominique
Bonnefoy-Cudraz, Eric
Laribi, Said
Henry, Patrick
Girerd, Nicolas
Zannad, Faiez
El Khoury, Carlos
Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey
title Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey
title_full Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey
title_fullStr Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey
title_full_unstemmed Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey
title_short Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey
title_sort management of suspected acute heart failure dyspnea in the emergency department: results from the french prospective multicenter defssica survey
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026775/
https://www.ncbi.nlm.nih.gov/pubmed/27639971
http://dx.doi.org/10.1186/s13049-016-0300-x
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