Opportunities for improvement in the diagnosis and treatment of heart failure

McCullough, Peter A.; Philbin, Edward F.; Spertus, John A.; Sandberg, Keisha R.; Sullivan, Roberta A.; Kaatz, Scott

doi:10.1002/clc.4960260507

Cited by 15 publications

(14 citation statements)

References 34 publications

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“…We have shown that when ACEIs and BBs are started within the first year following the diagnosis of CHF, reduced mortality is seen within a short period of follow-up. 28 Such an early, accurate diagnosis, followed by the initiation of evidence-based treatment, will likely have a large public health benefit. 26 In addition, multiple studies have demonstrated that an organized approach to medical management of CHF, once it is identified, can reduce hospitalizations and mortality.…”

Section: Limitationsmentioning

confidence: 99%

Uncovering Heart Failure in Patients with a History of Pulmonary Disease: Rationale for the Early Use of B‐type Natriuretic Peptide in the Emergency Department

McCullough

2003

Academic Emergency Medicine

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Plasma B-type natriuretic peptide (BNP) can reliably identify acute congestive heart failure (CHF) in patients presenting to the emergency department (ED) with acute dyspnea. Heart failure, asthma, and chronic obstructive pulmonary disease (COPD) are syndromes where dyspnea and wheezing are overlapping signs, and hence, these syndromes are often difficult to differentiate. Objective: To determine whether BNP can distinguish new-onset heart failure in patients with COPD or asthma presenting with dyspnea to the ED. Methods: The BNP Multinational Study was a seven-center prospective study of 1,586 adult patients presenting to the ED with acute dyspnea who had blinded BNP levels measured on arrival with a rapid, point-of-care device. This study evaluated the 417 patients with no previous history of heart failure and a history of asthma or COPD as a subgroup from the 1,586 adult patients in the BNP Multinational Study. The reference standard for CHF was adjudicated by two independent cardiologists, also blinded to BNP results, who reviewed all clinical data and standardized CHF scores. Results: A total of 417 subjects (mean age 62.2 years, 64.4% male) had a history of asthma or COPD without a history of CHF. Of these, 87/417 (20.9%, 95% CI ¼ 17.1% to 25.1%) were found to have CHF as the final adjudicated diagnosis. The emergency physicians identified a minority, 32/87 (36.8%), of these patients with CHF. The mean BNP values (6 SD) were 587.0 6 426.4 and 108.8 6 221.3 pg/mL for those with and without CHF (p , 0.0001). At a cutpoint of 100 pg/mL, BNP had the following decision statistics: sensitivity 93.1%, specificity 77.3%, positive predictive value 51.9%, negative predictive value 97.7%, accuracy 80.6%, positive likelihood ratio 4.10, and negative likelihood ratio 0.09. If BNP had been added to clinical judgment (high $ 80% probability of CHF), at a cutpoint of 100 pg/mL, 83/87 (95.4%) of the CHF subjects would have been correctly diagnosed. Multivariate analysis found BNP to be the most important predictor of CHF (OR ¼ 12.1, 95% CI ¼ 5.4 to 27.0, p , 0.0001). In the 87 subjects found to have CHF, 39.0%, 22.2%, and 54.8% were taking angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers (BBs), and diuretics on a chronic basis, respectively. Conclusions: The yield of adding routine BNP testing in patients with a history of asthma or COPD in picking up newly diagnosed CHF is approximately 20%. This group of patients presents a substantial therapeutic opportunity for the initiation and chronic administration of ACEI and BB therapy, as well as other CHF management strategies.

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Section: Limitationsmentioning

confidence: 99%

Uncovering Heart Failure in Patients with a History of Pulmonary Disease: Rationale for the Early Use of B‐type Natriuretic Peptide in the Emergency Department

McCullough

2003

Academic Emergency Medicine

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“…HF related rehospitalizations and Group Clinic Appointment Evaluations were summarized by reviewers blinded to group assignment. 34,35 All scores were measured at baseline, 6 and 12 months post-intervention follow-up using the empirically validated methods and rating scales in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments

Smith

Piamjariyakul

Dalton

et al. 2015

Journal of Cardiovascular Nursing

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Background The Self-Management and Care of Heart Failure through Group Clinics Trial (SMAC-HF) evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high risk heart failure (HF) patients. Objective The purpose of this article is to: (1) describe key SMAC-HF group clinic interactive learning strategies; (2) describe resources and materials used in the group clinic appointment; and (3) present results supporting this patient-centered group intervention. Methods This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients’: (1) group clinic session evaluations; (2) HF Self-Care Behaviors Skills; (3) HF related discouragement and quality of life scores and (4) HF related reshopitalizations during the 12 month follow-up. Also the costs of delivery of the group clinical appointments were tabulated. Results Overall, patients rated group appointments as 4.8 out of 5 on the “helpfulness” in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio (IRR) = 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ2(1) = 3.9, p = 0.04). The total cost for implementing five group appointments was $243.58 per patient. Conclusion The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF related hospitalizations.

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“…Karakteristični fizički znaci, kao što su jugularni venski puls, treći srčani ton, plućni pukoti i edem, često mogu biti odsutni kod bolesnika sa postojećom KSS [6]. Sa druge strane, rutinski laboratorijski testovi, elektrokardiogram i radiografija grudnog koša imaju malu prediktivnu vrednost [7]. Dostupnost ehokardiografije u urgentnim situacijamaje ograničena i često slabo primenjiva zbog akutnog i teškog fizičkog stanja bolesnika.…”

Section: Primena Natriuretskih Peptida U Kliničkoj Praksiunclassified