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

Abstract

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.

Prediction of short-term mortality in acute heart failure patients using minimal electronic health record data

“…These data were not available within our dataset, and so could not be incorporated as input features. BNP and NT-proBNP can be useful in diagnostic evaluation and have prognostic value, including for mortality prediction [ 9 , 53 – 56 ]. Models 33F and Top5F were able to perform well without these laboratory results, and adaptations of these models to clinical datasets in which these results are available have the potential to perform better.…”

“…Expenditures for AHF in the United States approach $39 billion per year, and are expected to almost double by 2030 [ 4 , 5 ]. An episode of AHF can herald the onset of rapidly progressive and ultimately fatal disease: up to half of heart failure patients die within 5 years of first diagnosis [ 6 – 9 ].…”

ASPN is a Potential Promising Biomarker for Common Heart Failure

“…Based on the functional status of the heart (systolic and diastolic function), HF is classi ed into HF with a reduced ejection fraction (HFrEF) and HF with a preserved ejection fraction (HFpEF) [36]. HFrEF is de ned by the impaired LV contraction and ejection function with an EF < 40%, while HFpEF refers to impaired LV relaxation and lling function with an EF > 50% (borderline range from > 40-55%) [1,36]. Additionally, HFrEF is the most common form.…”

Incidence and related factors of hypoxia associated with elderly femoral neck fractures in the emergency department setting

“…Test results such as high serum C‐reactive protein, B‐type natriuretic peptide, and/or D‐dimer were evaluated. Other tests like sputum culture or echocardiography were carried out when needed 6,7,8 . The attending physician, emergency physician, and/or internal physician comprehensively diagnosed the cause of hypoxia.…”

“…Other tests like sputum culture or echocardiography were carried out when needed. 6,7,8 The attending physician, emergency physician, and/or internal physician comprehensively diagnosed the cause of hypoxia. Hypoxia with unknown cause was defined as undetermined hypoxia after all examinations were carried out by the attending physician.…”