Low-risk acute heart failure patients: external validation of the Society of Chest Pain Center's recommendations.
Low-risk acute heart failure patients: external validation of the Society of Chest Pain Center's recommendations.
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DOI：
10.1097/hpc.0b013e3181b5a534
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发表时间：
2009-09-01
影响因子：
--
通讯作者：
Storrow, Alan B
中科院分区：
文献类型：
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作者：
Collins, Sean P;Lindsell, Christopher J;Storrow, Alan B
急性心力衰竭综合征（AHFS）的风险分层是有问题的。最近的一组建议描述了急诊科（ED）的AHFS患者，他们不符合高风险标准，可能是观察单元（OU）管理的良好候选人。本分析的目的是报告没有这些高风险标准的AHFS ED患者的结果。方法：我们对心力衰竭和用于快速诊断和初始治疗的听诊技术（hear - it）跨国研究进行了二次分析。HEARD-IT是一项多中心研究，旨在测试心电图对可能患有AHFS的患者的ED决策的影响。为了当前分析的目的，我们根据已发表的数据确定了一组不符合任何高风险标准的HEARD-IT患者。确定了这些患者出现不良结果的比例。结果：201例符合纳入标准的受试者平均年龄为64岁（SD: 13），男性61%，白人34%，黑人55%。共有25例（12.4%）心脏事件，其中1例因AHFS死亡。大多数心脏事件是与AHFS相关的30天再入院（16/25,64.0%）。结论：根据最近的共识指南，AHFS患者后续发病和死亡风险低，在OU或ED进行短暂观察后，可能是早期出院的良好候选者。需要进一步的前瞻性研究来确定实施这些标准对ED合并AHFS患者的影响。
INTRODUCTION: Risk-stratification in acute heart failure syndromes (AHFS) is problematic. A recent set of recommendations describes emergency department (ED) patients with AHFS who do not fulfill high-risk criteria and may be good candidates for observation unit (OU) management. The goal of this analysis was to report on the outcomes experienced by ED patients with AHFS who do not have any of these high-risk criteria.METHODS: We performed a secondary analysis of the HEart failure and Audicor technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) multinational study. HEARD-IT was a multicenter study designed to test the impact of acoustic cardiography on ED decision making in patients with possible AHFS. For the purposes of the current analysis we identified a subset of HEARD-IT patients who did not fulfill any high-risk criteria based on published data. The proportion of these patients who experienced an adverse outcome was determined.RESULTS: The 201 subjects who fulfilled the inclusion criteria had a mean age of 64 years (SD: 13), 61% were male, 34% were Caucasian, and 55% were black. There were a total of 25 (12.4%) cardiac events, including 1 death due to AHFS. The majority of the cardiac events were 30-day readmissions related to AHFS (16/25, 64.0%).CONCLUSION: AHFS patients at low-risk for subsequent morbidity and mortality based on recent consensus guidelines may be good candidates for early discharge after a brief period of observation in the OU or ED. Additional prospective research is needed to determine the impact of implementation of these criteria in ED patients with AHFS.