Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study

Abstract

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.

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

“…Along with pharmacological approaches, surgical implantable electrical devices for the treatment of HF patients with reduced ejection fraction (HFrEF) improve symptoms, reduce the risk of death and all-cause mortality in primary and secondary prevention [10, 28–30]. Nevertheless, in HFrEF patient outcomes remain unsatisfactory high with an increased risk for sudden death, worsening HF, frequent hospitalization for CV events and recurrent decompensation [31–33]. Given that currently available optimal medical drug and device therapies are insufficient to halt disease progression, an unmet need for other therapeutic approaches clearly exists [34–38].…”

Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

“…The prevalence of AHF management protocols can be considered rather high as the early diagnosis and treatment of AHF have been emphasized somewhat recently. [11][12][13] As expected, management protocols for STEMI were even more prevalent because of stronger evidence and recommendation in guidelines. 24 The importance of time to treatment in STEMI is unambiguous, as the condition evolves more abruptly compared with AHF.…”

“…11,12 However, the administration of pre-hospital medication seems scarce. 3,4,13,14 Moreover, earlier studies suggest that it might be difficult for EMS personnel to differentiate AHF from other underlying causes of dyspnoea [14][15][16][17] especially when the diagnosis is based only on patient's medical history and clinical signs and symptoms. 18,19 Illustrative data on the possibilities of EMS to treat and diagnose AHF in the pre-hospital setting in accordance with the guidelines are scarce.…”

“…[3][4][5] While the prognosis of AHF patients' remains poor, [6][7][8][9] the importance of early phase and pre-hospital management by emergency medical services (EMS) has been recently underlined. [10][11][12][13] Traditionally, EMS units are categorized by their resources for diagnosis and care and the level of personnel. Typically, advanced life support (ALS) units have a physician, nurse, or paramedic aboard (depending on the country) with readiness for intravenous (IV) line insertion and IV-medication administration.…”

Response

“…Although not commented by on García Garmendia et al or recorded in the original paper, another potential bias for our observational study is that some emergency prehospital teams are allowed to provide IV/subcutaneous morphine to patients with suspected AHF, and there is increasing evidence that prehospital care of AHF patients has an effect on outcomes. [2][3][4] Certainly, the multicentric randomized clinical trial MIMO (Midazolam Versus Morphine in Acute Pulmonary Edema), comparing midazolam vs morphine in patients with severe AHF at theED, 5 will better answer the question as to whether IV morphine is harmful for the treatment of AHF.…”