(Press-News.org) Sophia Antipolis, 22 May 2015: Urgent diagnosis and treatment in acute heart failure has been emphasised for the first time in joint recommendations published today in European Heart Journal.1
The consensus paper is the result of a novel collaboration between the Heart Failure Association (HFA) of the European Society of Cardiology (ESC), the European Society for Emergency Medicine and the Society for Academic Emergency Medicine in the USA.
Professor Alexandre Mebazaa, lead author and HFA board member, said: "This is the first guidance to insist that acute heart failure (AHF) is like acute coronary syndrome (ACS) in that it needs urgent diagnosis and appropriate treatment. In ACS when the coronary is occluded we say 'time is muscle' which means that the quicker the vessel is dilated, the more heart muscle is saved. The same principle is true for AHF."
He added: "By introducing the time to therapy concept together with new medications for AHF we hope to achieve the reductions in mortality and morbidity seen with ACS."
AHF presents as either an exacerbation of chronic heart failure or the abrupt onset of dyspnoea (shortness of breath) and significantly elevated blood pressure. It is a distressing and life-threatening condition that requires immediate medical attention and usually leads to urgent hospital admission.
Professor Abdelouahab Bellou, an author of the paper and past president of EuSEM, said: "If we treat patients with AHF earlier we can expect a decrease in mortality and morbidity. Failure to treat quickly aggravates underlying chronic heart failure and can induce complications including cardiogenic shock and acute respiratory distress. Patients may need to be intubated which can increase their risk of mortality."
The paper published today outlines:
An algorithm for the management of AHF
Tests and treatments to be performed pre-hospital, and in the emergency department, coronary care unit (CCU) or intensive care unit (ICU)
The role of nurses in the management of AHF
How to use oxygen therapy and ventilatory support
How to manage new and currently prescribed medicines
Criteria for discharge from hospital and recommendations for follow up.
The paper advocates addressing patients' anxiety by answering questions promptly and providing clear information, and communicating with families. Professor Mebazaa said: "Dyspnoea causes more anxiety for patients, families and doctors than chest pain. Anxiety is also caused by low oxygen levels in the brain. Unfortunately there are no medications to relax patients without worsening their respiration and blood oxygen levels. But we can reduce anxiety by talking to patients and families and giving oxygen."
He added: "Patients' anxiety levels depend on how the family is coping. If it's a first episode of AHF we need to take time to explain the condition to families. For frequent fliers2 we explain whether it's a similar or different episode to the last time."
Emphasis is given to follow up during the high risk period after discharge from hospital. Professor Mebazaa said: "Many patients die from AHF during the first hospitalisation. Around 30-40% of discharged patients are back in hospital within 30 days. This is contrast to most conditions, where patients are treated and do not return. We need to do everything we can to avoid readmissions in the first 30 days."
This is the first time cardiologists, emergency physicians, intensivists and nurses from Europe and the USA have joined forces to agree a treatment algorithm for patients with AHF. Professor Mebazaa said: "Inconsistency in medicine is never good for patients. Many patients with AHF are hospitalised many times and may receive different treatment for the same event in the emergency room, ICU or CCU. We hope to standardise care by recommending best contemporary practices based on the latest evidence."
He concluded: "We are at the beginning of the road in AHF. By providing fast and appropriate treatment we hope to mimic the successful journey of ACS and achieve significant reductions in mortality and morbidity."
INFORMATION:
Notes to editors
Notes and references
1 Recommendations on pre-hospital and hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. European Heart Journal. 2015; doi:10.1093/eurheartj/ehv066
2 Patients with multiple hospital admissions are sometimes referred to as frequent fliers.
ESC Heart Failure Guidelines
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal. 2012;33:1787-1847. doi:10.1093/eurheartj/ehs104
About the Heart Failure Association of the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
The Heart Failure Association (HFA) is a registered branch of the ESC. Its aim is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
http://www.escardio.org/communities/HFA/Pages/welcome.aspx
About the European Society for Emergency Medicine
The European Society for Emergency Medicine (EuSEM) is a non-profit making scientific organisation whose aim is to promote and foster the concept, philosophy and the art of emergency medicine throughout Europe.
http://www.eusem.org/
About the Society for Academic Emergency Medicine
The Society for Academic Emergency Medicine (SAEM) is dedicated to the improvement of care of the acutely ill and injured patient by improving research and education.
https://www.saem.org/
Blood pressure lowering drugs do not improve life expectancy among adults with diabetes and kidney disease, a new study of the global evidence published today in The Lancet reveals.
However, the study, which brings together 157 studies involving more than 43,000 adults with diabetes, shows that angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blocker (ARB) treatments, alone or in combination, are the most effective drug regimen for preventing end-stage kidney disease -- an important finding given that diabetes is now the leading cause of people ...
A study by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London has shown that mood instability occurs in a wide range of mental disorders and is not exclusive to affective conditions such as depression, bipolar disorder and anxiety disorder.
The research, published today in BMJ Open, also found that mood instability was associated with poorer clinical outcomes.
Taken together, these findings suggest that clinicians should screen for mood instability across all common mental health disorders. Targeted interventions ...
BUFFALO, N.Y. - Smokers are four times more likely than non-smokers to become frequent visitors of emergency rooms.
That is one of the findings uncovered by a preliminary study led by Jessica Castner, a University at Buffalo emergency room utilization researcher.
The research - which sought to shed light on whether patients are replacing visits to their primary care physicians with trips to hospital ERs- also found that Americans with chronic diseases use both services equally and that, overall, medical care visits have soared in recent years.
"There are a few super-users ...
Imagine someone hands you a smoothie and asks you to identify everything that went into it.
You might be able to discern a hint of strawberry or the tang of yogurt. But overall it tastes like a blend of indiscernible ingredients.
Now imagine that the smoothie is made of 20,000 ground-up cells from, say, the brain.
You could run tests to determine what molecules are in the sample, which is what scientists do now. That would certainly give you useful information, but it wouldn't tell you which cells those molecules originally came from. It would provide only an average ...
Many people who live in sub-Saharan Africa develop a natural immunity to malaria, through repeated exposure to Plasmodium parasites. Even so, the disease kills close to half a million children per year, according to the World Health Organization.
What factors can interfere with the development of immunity?
Infectious disease researchers at Emory are calling attention to a trouble-maker whose effects may be underappreciated: Epstein-Barr virus (EBV). Their experiments with mice show that co-infection with a virus closely related to EBV can make a survivable malaria parasite ...
Normal skin contains an unexpectedly high number of cancer-associated mutations, according to a study published in Science. The findings illuminate the first steps cells take towards becoming a cancer and demonstrate the value of analysing normal tissue to learn more about the origins of the disease.
The study revealed that each cell in normal facial skin carries many thousands of mutations, mainly caused by exposure to sunlight. In fact, around 25 per cent of skin cells in samples from people without cancer were found to carry at least one cancer-associated mutation. ...
Tropical rainforests have long been considered the Earth's lungs, sequestering large amounts of carbon dioxide from the atmosphere and thereby slowing down the increasing greenhouse effect and associated human-made climate change. Scientists in a global research project now show that the vast extensions of semi-arid landscapes occupying the transition zone between rainforest and desert dominate the ongoing increase in carbon sequestration by ecosystems globally, as well as large fluctuations between wet and dry years. This is a major rearrangement of planetary functions. ...
(SACRAMENTO, Calif.) -- Researchers at UC Davis have conducted a comprehensive study to determine whether pediatric telemedicine consultations with rural emergency departments save money compared to telephone consults. The answer is a resounding yes. While telemedicine systems are expensive to install and maintain, they more than pay their way, saving an average $4,662 per use. The study was published in the journal Medical Decision Making.
"Our previous work showed that telemedicine was good for kids, families and providers, but we didn't really address the cost issue," ...
Lawrence Livermore researchers have determined that a tunnel bomb explosion by Syrian rebels was less than 60 tons as claimed by sources.
Using seismic stations in Turkey, Livermore scientists Michael Pasyanos and Sean Ford created a method to determine source characteristics of near earth surface explosions. They found the above-ground tunnel bomb blast under the Wadi al-Deif Army Base near Aleppo last spring was likely not as large as originally estimated and was closer to 40 tons.
Seismology has long been used to determine the source characteristics of underground ...
This news release is available in French. Montreal, May 21, 2015 - A new study published by the team of Naguib Mechawar, Ph.D., a researcher at the Douglas Institute (CIUSSS de l'Ouest-de-l'île-de-Montréal) and Associate Professor in the Department of Psychiatry at McGill University, suggests that the integration of new neurons in the adult brain is a phenomenon more generally compromised in the brains of depressed patients.
This new work confirms that neurogenesis in the human olfactory bulb is a marginal phenomenon in adults. These findings shed light ...
