Prehospital Diagnosis and Treatment of Patients With Acute Heart Failure

Abstract

Introduction Early diagnosis and optimization of heart failure therapies in patients with acute heart failure (AHF), including in the prehospital setting, is crucial to improving outcomes. However, making the diagnosis of AHF in the prehospital setting is difficult. The goal of this study was to evaluate the accuracy of prehospital diagnosis (AHF versus not heart failure [HF]) in patients with acute dyspnea when compared to final hospital diagnosis. Methods We conducted a retrospective study of adult patients transported by emergency medical services (EMS) with a primary or secondary complaint of shortness of breath. Patients were identified through an EMS electronic database (ESO) and matched to their hospital encounter. ESO was reviewed for prehospital diagnosis and management. Hospital electronic medical records were reviewed to determine final hospital diagnosis, management in the emergency department and hospital, disposition, and length of stay. The primary outcome compared prehospital diagnosis to final hospital diagnosis, which served as our criterion standard. Results Of 199 included patients, 50 (25%) had a final diagnosis of AHF. Prehospital paramedic sensitivity and accuracy for AHF were 14% (7/50; confidence interval [CI] 0.06-0.26) and 77% (CI 0.70-0.82), respectively. In the 50 patients with AHF, 14 (28%) received nitroglycerin in the prehospital setting, while 27 (54.0%) patients were inappropriately treated with albuterol. Conclusion Prehospital paramedics had poor sensitivity and moderate accuracy for the diagnosis of AHF. A small percentage of patients ultimately diagnosed with AHF had HF therapy initiated in the prehospital setting. This data highlights the fact that AHF is difficult to diagnose in the prehospital setting and is commonly missed.

Safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema: A 4‐year review

“…25 Prior work has highlighted fears that paramedics cannot accurately and safely identify AHFS exacerbations with APE. 26,27 However, more recently published data suggest that paramedics can accurately identify decompensated APE and that prehospital high-dose intravenous NTG use is feasible. 21,22 We believe that our prior success may Additional potential benefits of bolus dose intravenous NTG are its relatively low cost and simplicity of dosing and administration.…”

“…Prior work has highlighted fears that paramedics cannot accurately and safely identify AHFS exacerbations with APE 26,27 . However, more recently published data suggest that paramedics can accurately identify decompensated APE and that prehospital high‐dose intravenous NTG use is feasible 21,22 .…”

Final Diagnoses and Mortality Rates Among Patients Receiving Inhaled Bronchodilators During Ambulance Transportation

“…[21] Not all patients experiencing respiratory distress receive treatment with inhaled bronchodilators; the utilization rate for these medications in cases of respiratory distress varies between 20% and 55%. [3,7,22] However, in the Central Denmark Region, it is recommended to administer inhaled bronchodilators to all patients having symptoms of prolonged expiration and respiratory distress. Inhaled bronchodilator treatment may serve as an identi er for a homogeneous group of patients with moderate to severe respiratory distress in the prehospital settingan unambiguously easy identi able patient cohort not previously examined.…”