Marie-France Seronde1, Said Laribi, Sean P Collins, Nicolas Deye, Damien Logeart, Patrick Plaisance, Alain Cohen-Solal, Alexandre Mebazaa. 1. aUMR-S 942 Inserm bDepartment of Emergency Medicine cIntensive Care Unit dDepartment of Cardiology eDepartment of Anesthesiology and Intensive Care fParis Diderot University, Sorbonne Paris Cité gDHU FIRE, Paris Diderot University hAPHP, Saint Louis Lariboisière University Hospitals, Paris iDepartment of Cardiology, EA3920, University Hospital Jean Minjoz, Besancon, France jDepartment of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Abstract
OBJECTIVES: Acute heart failure (AHF) is frequently encountered in the emergency department (ED) or in the cardiac care unit (CCU)/ICU. Discrimination between cardiac and noncardiac cause of dyspnea by clinical means and standard testing is sometimes inadequate. The aim of our study was to assess AHF diagnosis agreement as determined by: (a) the attending physician, (b) the hospital discharge diagnosis, and (c) an adjudication committee. PATIENTS AND METHODS: Between 2010 and 2011, consecutive patients arriving for dyspnea in our hospital were prospectively included. A convenience sample of patients was enrolled in this analysis. Patients were admitted through the ED (280 patients) or through CCU/ICU (112 patients) for undifferentiated dyspnea. RESULTS: Overall, few differences were observed between the initial diagnosis and the hospital discharge diagnosis or the adjudicated diagnosis. Among the 200 patients with an initial diagnosis of AHF, hospital discharge diagnosis confirmed AHF (alone or combined) in 191 (95.5%) patients and the adjudication committee confirmed AHF (alone or combined) in 196 (98%) patients. CONCLUSION: Our study showed considerable agreement between different AHF diagnostic standards. An initial AHF diagnosis on the basis of clinical signs and biological parameters utilizing B-type natriuretic peptide testing has high agreement and accuracy with the hospital discharge and adjudicated diagnosis of AHF. The present study also shows that the accuracy of the initial AHF diagnosis allows rapid inclusion in AHF trials. These results, if confirmed in a broader cohort of patients, suggest that the initial ED diagnosis is highly accurate and reliable to guide further inpatient management.
OBJECTIVES: Acute heart failure (AHF) is frequently encountered in the emergency department (ED) or in the cardiac care unit (CCU)/ICU. Discrimination between cardiac and noncardiac cause of dyspnea by clinical means and standard testing is sometimes inadequate. The aim of our study was to assess AHF diagnosis agreement as determined by: (a) the attending physician, (b) the hospital discharge diagnosis, and (c) an adjudication committee. PATIENTS AND METHODS: Between 2010 and 2011, consecutive patients arriving for dyspnea in our hospital were prospectively included. A convenience sample of patients was enrolled in this analysis. Patients were admitted through the ED (280 patients) or through CCU/ICU (112 patients) for undifferentiated dyspnea. RESULTS: Overall, few differences were observed between the initial diagnosis and the hospital discharge diagnosis or the adjudicated diagnosis. Among the 200 patients with an initial diagnosis of AHF, hospital discharge diagnosis confirmed AHF (alone or combined) in 191 (95.5%) patients and the adjudication committee confirmed AHF (alone or combined) in 196 (98%) patients. CONCLUSION: Our study showed considerable agreement between different AHF diagnostic standards. An initial AHF diagnosis on the basis of clinical signs and biological parameters utilizing B-type natriuretic peptide testing has high agreement and accuracy with the hospital discharge and adjudicated diagnosis of AHF. The present study also shows that the accuracy of the initial AHF diagnosis allows rapid inclusion in AHF trials. These results, if confirmed in a broader cohort of patients, suggest that the initial ED diagnosis is highly accurate and reliable to guide further inpatient management.
Authors: Tahar Chouihed; Stéphane Manzo-Silberman; Nicolas Peschanski; Sandrine Charpentier; Meyer Elbaz; Dominique Savary; Eric Bonnefoy-Cudraz; Said Laribi; Patrick Henry; Nicolas Girerd; Faiez Zannad; Carlos El Khoury Journal: Scand J Trauma Resusc Emerg Med Date: 2016-09-17 Impact factor: 2.953
Authors: Gerben Keijzers; Anne-Maree Kelly; Louise Cullen; Sharon Klim; Colin A Graham; Simon Craig; Win Sen Kuan; Peter Jones; Anna Holdgate; Charles Lawoko; Said Laribi Journal: BMJ Open Date: 2017-02-28 Impact factor: 2.692