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Rapid identification of heart failure in the emergency department
2010 AAHFN 6TH ANNUAL MEETING JUNE 24 – 26, 2010
Research Abstracts RAPID IDENTIFICATION OF HEART FAILURE IN THE EMERGENCY DEPARTMENT K.F. Miller, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; C.M. Lewis, A.J. Naftilan, Heart Failure Program, Vanderbilt University Medical Center, Franklin, TN; C.A. Jenkins, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; A.B. Storrow, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; S.K. Roll, S.P. Collins, C.J. Lindsell, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH Purpose: The purpose of this study is to describe common characteristics of patients with acute heart failure syndrome (AHFS) presenting to the emergency department (ED). Background: Rapid identification of patients with AHFS in a busy ED is challenging, yet vital for clinicians treating patients and researchers screening for study subjects. AHFS is difficult to recognize early as it often mirrors or accompanies other common ED presentations, such as acute coronary syndrome, and pulmonary and renal disease. In addition, patients have individualized symptoms and are often unclear of their disease process. By knowing common characteristics of patients with AHFS, clinicians and researchers are better placed to identify possible AHFS patients. Methods: We analyzed data from a multi-center, prospective, adult, ED cohort who presented between July 2007 and December 2009with signs and symptoms of AHFS, as defined using modified Framingham Criteria There were five study sites, two level-I academic trauma centers, and three community hospitals. Combines census at these sites is about 250,000 per year. Patient demographics, symptoms on presentation, past medical history, medications, and results of the physician interview were described using median (IQR) or N (%) as appropriate. AHFS status was defined based on the final ED diagnosis. Associations of presenting signs and symptoms, medical history, initial electrocardiogram and chest radiography with AHFS were Abstract text is taken directly from the submission site and printed as is
HEART & LUNG VOL. 39, NO. 4
tested using the Wilcoxon Rank Sum test or Pearson’s chisquare test. Results: Of the 838 subjects enrolled, 575 (69%) had AHFS and 263 (31%) did not. The median age of subjects was 64 (IQR = 52, 76) and 466 (56%) were male. Those with heart failure had chief complaints of shortness of breath 68% of the time compared to 49% in those without (p < 0.001). Prior history of heart failure, outpatient diuretic use, presence of rales, jugular vein distention (JVD), and paroxysmal night dyspnea (PND) were also more common in those with AHFS than those without (all p < 0.007). Chest radiographs with findings of pulmonary edema, cardiomegaly and pleural effusion were also more common in subjects with AHFS(all p < 0.001). Conclusion: An AHFS diagnosis is more common in ED patients presenting with a history of heart failure, JVD, PND, lung sounds with rales and home diuretic use. Chest radiograph with pulmonary edema, cardiomegaly, and pleural effusion(s) were also associated with AHFS. Any of these findings should raise suspicion for AHFS when attempting to rapidly identify ED patients presenting with AHFS. In addition, the results may be used to identify patients for inclusion in AHFS workup and treatment protocols.
HEALTH STATUS AND HEALTHRELATED QUALITY OF LIFE IN CONGESTIVE HEART FAILURE K.A. Landry, College of Nursing, Texas A&M Health Science Center, College Station, TX Purpose: The major purpose of this study was to examine the health status and health-related quality of life (HRQOL) of men and women with a diagnosis of CHF. Background: CHF is a serious chronic disease with high mortality. It affects 5 million Americans, and approximately 550,000 new cases will be diagnosed each year (AHA, 2006). According to the AHA (2004), 5 years after being diagnosed with CHF, the mortality rate is more than 50%. Under the age of 65, about 80% of men and 70% of women who have heart failure will die within 8 years (AHA, 2004). The problem is that there is very little information on gender differences and health outcomes as it relates to HRQOL and health status in CHF patients.
www.heartandlung.org
347
Research Abstracts RAPID IDENTIFICATION OF HEART FAILURE IN THE EMERGENCY DEPARTMENT K.F. Miller, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; C.M. Lewis, A.J. Naftilan, Heart Failure Program, Vanderbilt University Medical Center, Franklin, TN; C.A. Jenkins, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; A.B. Storrow, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; S.K. Roll, S.P. Collins, C.J. Lindsell, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH Purpose: The purpose of this study is to describe common characteristics of patients with acute heart failure syndrome (AHFS) presenting to the emergency department (ED). Background: Rapid identification of patients with AHFS in a busy ED is challenging, yet vital for clinicians treating patients and researchers screening for study subjects. AHFS is difficult to recognize early as it often mirrors or accompanies other common ED presentations, such as acute coronary syndrome, and pulmonary and renal disease. In addition, patients have individualized symptoms and are often unclear of their disease process. By knowing common characteristics of patients with AHFS, clinicians and researchers are better placed to identify possible AHFS patients. Methods: We analyzed data from a multi-center, prospective, adult, ED cohort who presented between July 2007 and December 2009with signs and symptoms of AHFS, as defined using modified Framingham Criteria There were five study sites, two level-I academic trauma centers, and three community hospitals. Combines census at these sites is about 250,000 per year. Patient demographics, symptoms on presentation, past medical history, medications, and results of the physician interview were described using median (IQR) or N (%) as appropriate. AHFS status was defined based on the final ED diagnosis. Associations of presenting signs and symptoms, medical history, initial electrocardiogram and chest radiography with AHFS were Abstract text is taken directly from the submission site and printed as is
HEART & LUNG VOL. 39, NO. 4
tested using the Wilcoxon Rank Sum test or Pearson’s chisquare test. Results: Of the 838 subjects enrolled, 575 (69%) had AHFS and 263 (31%) did not. The median age of subjects was 64 (IQR = 52, 76) and 466 (56%) were male. Those with heart failure had chief complaints of shortness of breath 68% of the time compared to 49% in those without (p < 0.001). Prior history of heart failure, outpatient diuretic use, presence of rales, jugular vein distention (JVD), and paroxysmal night dyspnea (PND) were also more common in those with AHFS than those without (all p < 0.007). Chest radiographs with findings of pulmonary edema, cardiomegaly and pleural effusion were also more common in subjects with AHFS(all p < 0.001). Conclusion: An AHFS diagnosis is more common in ED patients presenting with a history of heart failure, JVD, PND, lung sounds with rales and home diuretic use. Chest radiograph with pulmonary edema, cardiomegaly, and pleural effusion(s) were also associated with AHFS. Any of these findings should raise suspicion for AHFS when attempting to rapidly identify ED patients presenting with AHFS. In addition, the results may be used to identify patients for inclusion in AHFS workup and treatment protocols.
HEALTH STATUS AND HEALTHRELATED QUALITY OF LIFE IN CONGESTIVE HEART FAILURE K.A. Landry, College of Nursing, Texas A&M Health Science Center, College Station, TX Purpose: The major purpose of this study was to examine the health status and health-related quality of life (HRQOL) of men and women with a diagnosis of CHF. Background: CHF is a serious chronic disease with high mortality. It affects 5 million Americans, and approximately 550,000 new cases will be diagnosed each year (AHA, 2006). According to the AHA (2004), 5 years after being diagnosed with CHF, the mortality rate is more than 50%. Under the age of 65, about 80% of men and 70% of women who have heart failure will die within 8 years (AHA, 2004). The problem is that there is very little information on gender differences and health outcomes as it relates to HRQOL and health status in CHF patients.
www.heartandlung.org
347