Diagnosis and management of acute heart failure

Ural, Dilek; Çavuşoğlu, Yüksel; Eren, Mehmet; Karaüzüm, Kurtuluş; Temizhan, Ahmet; Yılmaz, Mehmet; Zoghi, Mehdi; Ramassubu, Kumudha; Bozkurt, Biykem

doi:10.5152/anatoljcardiol.2015.6567

Cited by 27 publications

(20 citation statements)

References 142 publications

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“…The remaining 111 patients were divided into two groups according to age, the VE group (age ≥85 years, n=45) and the not very elderly (NVE) group (age <85 years, n=66). ADHF was diagnosed according to the Framingham criteria as showing at least two of the following clinical signs: dyspnea, orthopnea, rales and a third heart sound, peripheral edema, pulmonary congestion, or jugular vein dilatation ( 13 , 16 , 17 ). The conventional primary therapy for ADHF included some diuretics, inhibitors of renin–angiotensin system (RAS inhibitors), vasodilators, beta-blockers, and noninvasive positive pressure ventilation.…”

Section: Methodsmentioning

confidence: 99%

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure

Niikura

Iijima²,

Anzai³

et al. 2017

Anatol J Cardiol

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Objective:The establishment of an optimal strategy for elderly patients with acute decompensated heart failure (ADHF) is currently an important issue. Particularly in very elderly (VE) patients, ADHF is associated with a poor prognosis. We therefore aimed to evaluate the efficacy and safety of the early use of tolvaptan (TLV) in VE patients.Methods:Of 245 patients with ADHF admitted between March 2013 and July 2014, we prospectively enrolled 111 patients with TLV first administered within 24 h of hospitalization. These were divided into two groups according to the age: VE (≥85 years, n=45) and not very elderly (NVE, <85 years, n=66). The endpoints were the incidence of worsening renal function, death by any cause, or the length of hospital stay.Results:There were no significant differences between the two groups in the incidence of worsening renal function (26.7% in VE vs. 25.8% in not VE, p=0.92), dose of TLV after hospitalization (7.4±0.7 vs. 7.5±1.3 mg/day, p=0.63), mean duration of the use of TLV (4.3±3.5 vs. 5.4±4.8 days, p=0.17), or mean length of hospital stay (16.5±7.8 vs. 15.7±8.0 days, p=0.64).Conclusion:TLV shows similar efficacy and safety in both VE and NVE groups. Even for VE patients with ADHF, initiation of TLV with standard diuretic treatment may have the potential not to increase the incidence of worsening renal function.

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Section: Methodsmentioning

confidence: 99%

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure

Niikura

Iijima²,

Anzai³

et al. 2017

Anatol J Cardiol

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“…HF with preserved EF refers to patients with an EF > 50%, while HF with reduced EF refers to patients with an EF < 40%. Borderline preserved EF is defined by HF with an EF of 41–50% 3,4,17,18,29. The most common form is HF with reduced EF, which is primarily related to a decrease in the functional myocardium (typically associated with ischemic disease or a prior myocardial infarction) 3,4,34.…”

Section: Discussionmentioning

confidence: 99%

“…HF is more common in males until the age of 65, at which time males and females are equally affected 25–28. Patients with HF average at least two hospital admissions per year 25,29,30. Among patients who are admitted with AHF, over 80% have a prior history of HF, referred to as decompensated heart failure 20–23.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review

Long

Koyfman

Gottlieb

2019

WestJEM

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Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended.

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“…[ 3 ] Elaborated workup, including laboratory and radiological studies, electrocardiography (ECG), and echocardiogram are commonly used to diagnose AHF in the ED. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure

et al. 2020

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OBJECTIVES: Although the reliability of e-point septal separation (EPSS) and caval index (CI) is proven in the diagnosis of acute heart failure (AHF), how much they contribute to the initial clinical impression is unclear. This study aimed to determine the diagnostic contribution of EPSS and CI to the initial clinical impression of AHF. METHODS: This is a prospective observational study conducted in an academic emergency department (ED). The patients admitted to the ED with acute undifferentiated dyspnea were included. Primary diagnosis was made after an initial clinical evaluation, and a secondary diagnosis was made after EPSS and CI measurements. Independent cardiologists made the final diagnosis. The primary outcome was the diagnostic contribution of EPSS and CI to the primary diagnosis. RESULTS: A total of 182 patients were included in the study. The primary diagnosis was found with a sensitivity of 0.55 and specificity of 0.84 and the secondary diagnosis was determined with a sensitivity of 0.78 and specificity of 0.83 in predicting the final diagnosis. The agreement coefficient between the primary and final diagnosis was 0.44 and between the secondary diagnosis and the final diagnosis was 0.61. When the primary diagnosis was coherent with secondary diagnosis, sensitivity and specificity were found to be 0.74 and 0.90, respectively. CONCLUSION: Although a detailed history and physical examination are the essential factors in shaping clinical perception, CI and EPSS combined significantly contribute to the initial clinical impression.

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Diagnosis and management of acute heart failure

Cited by 27 publications

References 142 publications

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure

Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review

Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure

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