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Harjola P, Tarvasmäki T, Barletta C, Body R, Capsec J, Christ M, Garcia-Castrillo L, Golea A, Karamercan MA, Martin PL, Miró Ò, Tolonen J, van Meer O, Palomäki A, Verschuren F, Harjola VP, Laribi S. The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study. BMC Emerg Med 2022; 22:27. [PMID: 35164693 PMCID: PMC8842939 DOI: 10.1186/s12873-022-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.
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Affiliation(s)
- Pia Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung Cent, Helsinki University Hospital, Helsinki, Finland
| | - Cinzia Barletta
- Servicio Urgencias Hospital Marqués de Valdecilla, Santander, Spain
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, England
| | - Jean Capsec
- Department of Public Health, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Michael Christ
- Department of Emergency Care, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Adela Golea
- Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mehmet A Karamercan
- Emergency Medicine Department, Faculty of Medicine, Gazi University, Ankara, Turkey.,Department of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Paul-Louis Martin
- School of Medicine and CHU Tours, Emergency Medicine Department, Tours University, Tours, France
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jukka Tolonen
- Internal Medicine, University of Helsinki and Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Oene van Meer
- Leiden University Medical Center, Leiden, The Netherlands
| | - Ari Palomäki
- Emergency Medicine, Campus of Tampere, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Said Laribi
- School of Medicine and CHU Tours, Emergency Medicine Department, Tours University, Tours, France
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Miró Ò, Harjola P, Rossello X, Gil V, Jacob J, Llorens P, Martín-Sánchez FJ, Herrero P, Martínez-Nadal G, Aguiló S, López-Grima ML, Fuentes M, Álvarez Pérez JM, Rodríguez-Adrada E, Mir M, Tost J, Llauger L, Ruschitzka F, Harjola VP, Mullens W, Masip J, Chioncel O, Peacock WF, Müller C, Mebazaa A. The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department. Eur Heart J Acute Cardiovasc Care 2021; 10:487-496. [PMID: 33580790 DOI: 10.1093/ehjacc/zuaa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/14/2022]
Abstract
AIMS The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED. METHODS AND RESULTS In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL = 7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085-1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146-1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995-1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817-1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845-1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915-1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings. CONCLUSION Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain.,The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
| | - Pia Harjola
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Emergency Medicine and Services, Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland, Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Xavier Rossello
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Cardiology Department & Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Pablo Herrero
- Emergency Department , Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gemma Martínez-Nadal
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain.,The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | | | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - María Mir
- Emergency Department, Hospital Infanta Leonor, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | - Lluís Llauger
- Emergency Department, Hospital de Vic, Barcelona, Catalonia, Spain
| | - Frank Ruschitzka
- UniversitätsSpital Zürich, University Heart Center Zurich, Zurich, Switzerland
| | - Veli-Pekka Harjola
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Emergency Medicine and Services, Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland, Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Josep Masip
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Cardiology Department, Hospital Sanitas CIMA, Barcelona, Catalonia, Spain
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - W Frank Peacock
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christian Müller
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Anesthesiology and Critical Care Medicine, InsermU942-MASCOT, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
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Harjola P, Miró Ò, Martín-Sánchez FJ, Escalada X, Freund Y, Penaloza A, Christ M, Cone DC, Laribi S, Kuisma M, Tarvasmäki T, Harjola VP. Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure. ESC Heart Fail 2019; 7:289-296. [PMID: 31701683 PMCID: PMC7083500 DOI: 10.1002/ehf2.12524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/21/2019] [Accepted: 09/01/2019] [Indexed: 12/28/2022] Open
Abstract
Aim To illustrate the pre‐hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre‐hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre‐hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point‐of‐care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST‐elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12‐lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point‐of‐care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non‐invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST‐elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre‐hospital conditions.
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Affiliation(s)
- Pia Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona, 08036, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Facultad de Medicina de Universidad Complutense de Madrid, Madrid, Spain
| | | | - Yonathan Freund
- Emergency Department, Hôpital Pitie-Salpêtrière, Assistance Publique-Hôpitaux de Paris, INSERM 1166, Sorbonne University, Paris, France
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Michael Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - David C Cone
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Said Laribi
- Département de Médecine d'Urgence, CHRU de Tours, Faculté de Médecine, Université de Tours Centre d'Étude des Pathologies Respiratoires - Inserm U1100, Tours, France
| | - Markku Kuisma
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Tarvasmäki
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.,Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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4
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Harjola P, Tolonen J, Boyd J, Mattila J, Koski R, Palomäki A, Kuisma M, Harjola VP. The role of pre-hospital management in acute heart failure. Eur J Heart Fail 2018; 19:287-289. [PMID: 28157271 DOI: 10.1002/ejhf.712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/16/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Pia Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland
| | - Jukka Tolonen
- Internal Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland
| | - James Boyd
- Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Juho Mattila
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Reijo Koski
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Ari Palomäki
- Emergency Medicine, University of Tampere, Tampere, Finland.,Department of Emergency Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Markku Kuisma
- Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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Miró Ò, Hazlitt M, Escalada X, Llorens P, Gil V, Martín-Sánchez FJ, Harjola P, Rico V, Herrero-Puente P, Jacob J, Cone DC, Möckel M, Christ M, Freund Y, di Somma S, Laribi S, Mebazaa A, Harjola VP. Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study. Clin Res Cardiol 2017; 107:347-361. [PMID: 29285622 DOI: 10.1007/s00392-017-1190-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/27/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). METHODS We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. RESULTS We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115-2.811; p = 0.016), and 1.939 (95% CI 1.114-3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. CONCLUSIONS Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain. .,, .
| | - Melissa Hazlitt
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Pere Llorens
- Home Hospitalization and Short Stay Unit, Emergency Department, Hospital General de Alicante, Alicante, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Pia Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital,, Helsinki University, Helsinki, Finland
| | - Verónica Rico
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David C Cone
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Martin Möckel
- Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany
| | - Michael Christ
- .,Department of Emergency and Critical Care Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Yonathan Freund
- Emergency Department, Hôpital Pitie-Salpêtrière, Sorbonne University, Paris, France
| | - Salvatore di Somma
- .,Department of Medical-Surgery Sciences and Translational Medicine Emergency Department Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Said Laribi
- .,Emergency Medicine Department, School of Medicine and Tours University Hospital, François-Rabelais University, 37044, Tours, France
| | - Alexandre Mebazaa
- .,Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France
| | - Veli-Pekka Harjola
- .,Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital,, Helsinki University, Helsinki, Finland
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Harjola P, Harjola VP. [Can we do more for patients with acute heart failure before arrival at the hospital?]. Emergencias 2017; 29:221-222. [PMID: 28825275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Pia Harjola
- Emergency Medicine, Helsinki University. Division of Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finlandia
| | - Veli-Pekka Harjola
- Emergency Medicine, Helsinki University. Division of Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finlandia
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Harjola P, Meurala H, Frick MH. Prevention of deep venous thrombosis and thrombo-embolism by dipyridamole and acetylsalicylic acid after reconstructive arterial surgery. J Cardiovasc Surg (Torino) 1980; 21:451-4. [PMID: 7419561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A series of 400 consecutive patients subjected to reconstructive arterial surgery were randomly allocated into four equal groups in order to study the effect of dipyridamole and acetylsalicylic acid (ASA) in the prevention of deep venous thrombosis and pulmonary embolism. There were 11 drop-outs. In the dipyridamole-ASA group there were no thrombotic complications while in the control group without antithrombotic therapy five cases of deep venous thrombosis and two cases of fatal pulmonary embolism were encountered (p < 0.05). In the groups receiving either dipyridamole or ASA alone two and four cases of deep venous thrombosis, respectively, were found. It is concluded that treatment with dipyridamole and ASA combined is useful in preventing postoperative thrombotic complication after peripheral vascular reconstructive surgery.
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Tala P, Kyllönen KE, Harjola P, Appelqvist P. Aneurysms of the thoracic and abdominal aorta. II. Experience with surgical management of 32 cases. Ann Chir Gynaecol Fenn 1967; 56:278-285. [PMID: 5591929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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