Beyond Pulmonary Edema

Diagnostic, Risk Stratification, and Treatment Challenges of Acute Heart Failure Management in the Emergency Department

Sean Collins, Alan B. Storrow, J. Douglas Kirk, Peter S. Pang, Deborah B. Diercks, Mihai Gheorghiade

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

The majority of heart failure hospitalizations in the United States originate in the emergency department (ED). Current strategies for acute heart failure syndromes have largely been tailored after chronic heart failure guidelines and care. Prospective ED-based acute heart failure syndrome trials are lacking, and current guidelines for disposition are based on either little or no evidence. As a result, the majority of ED acute heart failure syndrome patients are admitted to the hospital. Recent registry data suggest there is a significant amount of heterogeneity in acute heart failure syndrome ED presentations, and diagnostics and therapeutics may need to be individualized to the urgency of the presentation, underlying pathophysiology, and acute hemodynamic characteristics. A paradigm shift is necessary in acute heart failure syndrome guidelines and research: prospective trials need to focus on diagnostic, therapeutic, and risk-stratification algorithms that rely on readily available ED data, focusing on outcomes more proximate to the ED visit (5 days). Intermediate outcomes (30 days) are more dependent on inpatient and outpatient care and patient behavior than ED management decisions. Without these changes, the burden of acute heart failure syndrome care is unlikely to change. This article proposes such a paradigm shift in acute heart failure syndrome care and discusses areas of further research that are necessary to promote this change in approach.

Original languageEnglish (US)
Pages (from-to)45-57
Number of pages13
JournalAnnals of Emergency Medicine
Volume51
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Pulmonary Edema
Hospital Emergency Service
Heart Failure
Therapeutics
Guidelines
Ambulatory Care
Research
Registries
Inpatients
Hospitalization
Hemodynamics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Beyond Pulmonary Edema : Diagnostic, Risk Stratification, and Treatment Challenges of Acute Heart Failure Management in the Emergency Department. / Collins, Sean; Storrow, Alan B.; Kirk, J. Douglas; Pang, Peter S.; Diercks, Deborah B.; Gheorghiade, Mihai.

In: Annals of Emergency Medicine, Vol. 51, No. 1, 01.2008, p. 45-57.

Research output: Contribution to journalArticle

Collins, Sean ; Storrow, Alan B. ; Kirk, J. Douglas ; Pang, Peter S. ; Diercks, Deborah B. ; Gheorghiade, Mihai. / Beyond Pulmonary Edema : Diagnostic, Risk Stratification, and Treatment Challenges of Acute Heart Failure Management in the Emergency Department. In: Annals of Emergency Medicine. 2008 ; Vol. 51, No. 1. pp. 45-57.
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