Study on patients with heart failure

Baggish, A. L., Siebert, U., Lainchbury, J. G., Cameron, R., Anwaruddin, S., Chen, A., . . .

Januzzi, J. L. (2006). A validated clinical and biochemical score for the diagnosis of

acute heart failure: The proBNP investigation of dyspnea in the emergency department (PRIDE) acute heart failure score. American Heart Journal, 151(1), 48-54.

A study consisting of 599 patients with dyspnea, had their amino-terminal pro-brain natriuretic peptide (NT-proBNP) and clinical assessment examined and tested to identify heart failure (HF). The study was done on patients that presented with dyspnea and excluded patients younger than 21 years of age, with severe renal insufficiency, chest trauma, coronary ischemia, greater than a 2-hour time delay of intravenous loop diuretic administration, and un-blinded natriuretic peptide level measurement. The purpose of this research was to detect heart failure early in the emergency room using the PRIDE database. The PRIDE acute heart failure scores are used to diagnose heart failure, and consists of elevated NT-proBNP results, interstitial edema on chest x-ray, orthopnea, absence of fever, current loop diuretic use, 75 years of age or older, rales on auscultation, and the absence of a cough. The scoring then reveals either low, intermediate, or high possibility of HF. A score of 6/intermediate or higher is considered a positive for heart failure.

Karlström, P., Johansson, P., Dahlström, U., Boman, K., & Alehagen, U. (2017). The impact of

time to heart failure diagnosis on outcomes in patients tailored for heart failure treatment by use of natriuretic peptides. results from the uPSTEP study. International Journal of Cardiology, 236, 315-320. doi:10.1016/j.ijcard.2017.02.054

This was a study based on information from the UPSTEP study, which was a study on 252 patients on average aged 71 years old, and diagnosed with HF. The UPSTEP study was a random, parallel group, and multicenter study using a PROBE (prospective, randomized, open, blinded evaluation) design. They studied patients with worsening HF, NYHA (New York Heart Association) class II–IV, ejection fraction less than 40%, and a BNP greater than 150 ng/L for people 75 years old and younger, and a BNP greater than 300 ng/L for people 75 years old and older. The patients were randomized into either a BNP-guided HF treatment group or a conventional HF treatment group. BNP’s were only measured for the BNP-guided group during the study in order to evade bias in the conventional HF group, only in the beginning did both groups have their BNP measured. The BNP showed to increase when heart failure prolonged and prolonged heart failure showed to have more cardiac fibrosis which increases the risk for morbidity and mortality.

Verdú, J., Comín-Colet, J., Domingo, M., Lupón, J., Gómez, M., Molina, L., . . . Bruguera-

Cortada, J. (2012). Rapid point-of-Care nT-proBNP optimal cut-off point for heart failure diagnosis in primary care. Revista Española De Cardiología (english Edition), 65(7), 613-619. doi:10.1016/j.rec.2012.01.021

The purpose of this study was to find a cut-off value of N-terminal pro-B-type natriuretic peptide point for a heart failure diagnosis. In the study they studied 220 people, with no history of heart failure in order to determine how to properly diagnose heart failure in an out-patient setting. They were contacted by phone then went to a clinic to have their initial ECG, chest X-ray, clinical history, physical examination, and echocardiography. Cardiologist made a diagnosis of heart failure blinded to N-terminal pro-B-type natriuretic peptide value, and used the European Society of Cardiology diagnosis criteria. All of the patients diagnosed with HF had a NT-proBNP greater than 280 pg/mL, making that the best cut-off for primary care diagnosis of HF.

Ezekowitz, J. A., Kaul, P., Bakal, J. A., Quan, H., & McAlister, F. A. (2011). Trends in heart

failure care: Has the incident diagnosis of heart failure shifted from the hospital to the emergency department and outpatient clinics? European Journal of Heart Failure, 13(2), 142-7. doi:10.1093/eurjhf/hfq185

The purpose of this study was to define the occurrence, frequency, or outcomes for heart failure (HF) patients diagnosed in the outpatient or emergency department (ED) setting. This study was done in Alberta, Canada and consisted of 82,323 HF patients from 1999 to 2007. They were not involved directly with patients but studied developments and clinical results over time. In the study they revealed the percentage of patients diagnosed with HF in different settings, in a universal outpatient clinic was 45.7%, a specialty outpatient clinic was 4.0%, in the ED was 13.7%, or in the hospital was 36.6%. The study was able to distinguish that one-year mortality varied depending on where the patient was diagnosed. Patients diagnosed in a universal outpatient clinic had 6.6% chance, a specialty outpatient clinic was 7.5% chance, in the ED was 19.1% chance, or in the hospital was 29.8% chance of mortality in one year.

Génot, N., Mewton, N., Bresson, D., Zouaghi, O., Francois, L., Delwarde, B., . . . Bonnefoy-

Cudras, E. (2015). Bioelectrical impedance analysis for heart failure diagnosis in the ed. The American Journal of Emergency Medicine, 33(8), 1025-9. doi:10.1016/j.ajem.2015.04.021

This study was done to assess the use of bioimpedance vector analysis (BIVA) to diagnose acute heart failure (AHF) in patients that presented with acute dyspnea in the emergency department (ED). The study consisted of 77 patients lasted four months from February to June in 2013 at the Emergency Cardiology Consultation (ECC) at the University Hospital of L. Pradel at Bron, France. Patients were referred by themselves, their primary doctor, or emergency services. Patients who presented to the ECC with symptoms of dyspnea were selected for the study. The researches used 3 models to measure how BIVA is correlates with HF. They compared BIVA to age, glomerular filtration rate (GFR), and brain natriuretic peptide BNP. BIVA was shown to not improve diagnosis of HF, but can actually be an important tool in determining if the treatment regimen is effective, by determining early fluid changes in patients in order to adjust diuretics accordingly.

Carey, S. A., Bass, K., Saracino, G., East, C. A., Felius, J., Grayburn, P. A., . . . Hall, S. A.

(2017). Probability of accurate heart failure diagnosis and the implications for hospital readmissions. The American Journal of Cardiology, 119(7), 1041-1046. doi:10.1016/j.amjcard.2016.12.010

Researchers studied charts of patients from 14 hospitals in a city health care system from January 1, 2012, to December 31, 2012. Patients viewed were 18 years or older, and met the International Classification of Diseases, and the Ninth Revision (ICD-9) code for a primary diagnosis of heart failure (HF) during discharge, had an echocardiogram within 6 months of admission, and had a Brain natriuretic peptide (BNP) level during their admission. They did this study in order to see the accuracy of a HF diagnosis and the association to readmissions. From that they selected 750 random qualified patients and their electronic medical records were retrieved to verify their appropriateness, and to evaluate the probability of a correct HF diagnosis during discharge. They found that 38 (5%) patients didn’t fully qualify for a heart failure diagnosis, and 125 (18%) patients were readmitted within 30 days from discharge.

Research question: does teaching patients with heart failure risk factors or with early onset of heart failure about the signs, symptoms and early interventions of heart failure, decrease the prevalence and or outcome of heart failure.

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