|
Heart Failure in the Pre-Hospital Setting
Acute Decompensated Heart Failure (ADHF) is a disease of epidemic proportions. Approximately 5% of the US healthcare budget is spent on the diagnosis and management of heart failure. To date, paramedics have had little in the way of diagnostic tools to assist in confirming the diagnosis of CHF. A study of 222 patients with dyspnea noted an overall prehospital error rate of 23% in diagnosis of heart failure, and that number jumped to 46% when the failure was accompanied by a co-morbidity such as COPD, asthma, CAD, MI or diabetes.
Value of Early Diagnosis
IV Vasoactives Started |
ED (n=4,096) |
Inpatient Unit (n=3,499) |
Mortality (%) |
4.3 |
10.9 |
Hospital Length Of Stay (Days) |
4.5 |
7.0 |
Transfer to ICU/CCU (%) |
4 |
20 |
Invasive Procedures (%) |
19 |
27 |
Prolonged hospitalization |
26 |
49 |
The Acute Decompensated Heart Failure National Registry (ADHERE) was designed to provide hospitals and clinicians with data to improve the quality of care for patients with ADHF. Data shown above suggest the earlier diagnosis and treatment in the ED results in better clinical outcomes and shorter lengths of stay, both of which help to lower the overall cost of care.
Eighty percent of patients with heart failure present to the ED and many of them arrive via emergency medical transport services. Studies suggest accurate pre-hospital diagnosis and treatment improves patient outcomes. However, the administration of heart failure drugs to patients with non-cardiac dyspnea does increase patient mortality. Therefore, accurate diagnosis is important to ensure heart failure patients receive appropriate treatment and have the best clinical outcome.
Pozner CN, Levine BS, Shapiro N, Hanrahan JP, et al. Concordance of field and emergency department assessment in the pre-hospital management of patients with dyspnea. Prehospital Emerg Care. December 2003:440-444.
Top
|
