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Collins S, Storrow AB, Albert NM, Butler J, Ezekowitz J, Felker GM, Fermann GJ, Fonarow GC, Givertz MM, Hiestand B, Hollander JE, Lanfear DE, Levy PD, Pang PS, Peacock WF, Sawyer DB, Teerlink JR, Lenihan DJ. Early management of patients with acute heart failure: state of the art and future directions. A consensus document from the society for academic emergency medicine/heart failure society of America acute heart failure working group. J Card Fail 2015; 21:27-43. [PMID: 25042620 PMCID: PMC4276508 DOI: 10.1016/j.cardfail.2014.07.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/28/2014] [Accepted: 07/10/2014] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition decisions cannot be underestimated. Predictive instruments that identify a cohort of patients safe for ED discharge, while simultaneously addressing barriers to successful outpatient management, have the potential to significantly impact quality of life and resource expenditures.
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Affiliation(s)
- Sean Collins
- Nashville Veterans Affairs Medical Center and Vanderbilt University, Nashville, Tennessee.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter S Pang
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - John R Teerlink
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California
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Collins SP, Storrow AB, Levy PD, Albert N, Butler J, Ezekowitz JA, Michael Felker G, Fermann GJ, Fonarow GC, Givertz MM, Hiestand B, Hollander JE, Lanfear DE, Pang PS, Frank Peacock W, Sawyer DB, Teerlink JR, Lenihan DJ. Early management of patients with acute heart failure: state of the art and future directions--a consensus document from the SAEM/HFSA acute heart failure working group. Acad Emerg Med 2015; 22:94-112. [PMID: 25423908 DOI: 10.1111/acem.12538] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 08/24/2014] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) afflicts nearly 6 million Americans, resulting in 1 million emergency department (ED) visits and over 1 million annual hospital discharges. The majority of inpatient admissions originate in the ED; thus, it is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics, and alternatives to hospitalization. This article discusses contemporary ED management as well as the necessary next steps for ED-based acute HF research.
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Affiliation(s)
- Sean P. Collins
- The Department of Emergency Medicine; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
| | - Alan B. Storrow
- The Department of Emergency Medicine; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
| | - Phillip D. Levy
- The Department of Emergency Medicine; Wayne State University; Detroit MI
| | - Nancy Albert
- The Division of Cardiology; Cleveland Clinic; Cleveland OH
| | - Javed Butler
- The Division of Cardiology; Emory University; Atlanta GA
| | | | | | - Gregory J. Fermann
- The Department of Emergency Medicine; University of Cincinnati; Cincinnati OH
| | - Gregg C. Fonarow
- The Division of Cardiology; Ronald Reagan-UCLA Medical Center; Los Angeles CA
| | | | - Brian Hiestand
- The Department of Emergency Medicine; Wake Forest University; Winston-Salem NC
| | - Judd E. Hollander
- The Department of Emergency Medicine; Thomas Jefferson University; Philadelphia PA
| | | | - Peter S. Pang
- The Department of Emergency Medicine; Northwestern University; Chicago IL
| | - W. Frank Peacock
- The Department of Emergency Medicine; Baylor University; Houston TX
| | - Douglas B. Sawyer
- The Department of Emergency Medicine; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
| | - John R. Teerlink
- The Division of Cardiology; San Francisco Veterans Affairs Medical Center; University of California at San Francisco; San Francisco CA
| | - Daniel J. Lenihan
- The Division of Cardiology; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
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