Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes

Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes

1st May 2007
American College of Emergency Physicians
Summary, Abstract,

Source: National Guidelines Clearinghouse

GUIDELINE OBJECTIVE(S)
  • To focus on critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected heart failure
  • To address the following critical questions:
    1. Does a B-type natriuretic polypeptide (BNP) or N-terminal (NT)-ProBNP measurement improve the diagnostic accuracy over standard clinical judgment in the assessment of possible acute heart failure syndromes in the emergency department (ED)?
    2. Is there a role for noninvasive positive-pressure ventilatory support in the ED management of patients with acute heart failure syndromes and respiratory distress?
    3. Should vasodilator therapy (e.g., nitrates, nesiritide, and angiotensin-converting enzyme [ACE] inhibitors) be prescribed in the ED management of patients with acute heart failure syndromes?
    4. Should diuretic therapy be prescribed in the ED management of patients with acute heart failure syndromes?
TARGET POPULATION

This guideline is intended for adult patients presenting to the emergency department (ED) with symptoms or signs suggestive of acute heart failure.

Note: This guideline is not intended to address the care of those patients presenting with acute ST-elevation myocardial infarction, high-output heart failure, cardiogenic shock, renal failure, valvular emergencies, or the care of pediatric patients.

INTERVENTIONS AND PRACTICES CONSIDERED
  1. B-type natriuretic polypeptide (BNP) or N-terminal (NT)-ProBNP measurement
  2. Noninvasive positive-pressure ventilatory support
  3. Vasodilator therapy (e.g., nitrates, nesiritide, and angiotensin-converting enzyme [ACE] inhibitors)
  4. Diuretic therapy
MAJOR OUTCOMES CONSIDERED
  • Sensitivity and specificity of testing
  • Treatment costs
  • Time to discharge
  • Pulmonary and hemodynamic function
  • Intubation rate
  • Length of hospital stay
  • Mortality
  • Incidence of acute myocardial infarction
  • Symptoms of heart failure
  • Renal function