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Emergency Department Management of Acute Heart Failure: Research Challenges and Opportunities
This working group was organized by the National Heart, Lung, and Blood Institute (NHLBI) to address the challenges of managing acute heart failure syndrome (AHFS) in the emergency department (ED). The purpose of the meeting was to provide an interdisciplinary forum on promising and novel life saving AHFS therapies in the ED and to provide clinical research recommendations to the NHLBI regarding research directions that will best address the most critical areas in ED AHFS management. The working group provided the unique opportunity to bring together experts from both cardiology and emergency medicine. The workshop was held at the Cloister Conference Center, NIH, Bethesda, MD, on August 20-21, 2009.
Management of AHF in ED Setting: A Unique Opportunity to Improve Care and Survival
The participants agreed that there is a critical need for evidence-based management of AHFS in the ED setting. Most of the existing therapies for AHFS have not been tested rigorously or prospectively and most current therapies are used based on the experience and the opinions of experts (Level of Evidence C). In addition, most new therapies and technologies have not fulfilled the expectations to significantly improve either acute or long-term survival.
Two major management concepts were discussed: 1) the need for the early identification of patients who are at low vs. higher risk, allowing direct discharge from the ED for those at low risk and direct admission from the ED for those at high risk who do not respond to therapy; and, 2) the need for better understanding of early injury to both the heart and other organs, the contribution of this injury to the pathophysiology of AHFS, and the impact it may have on potential response to therapy in the ED setting.
Future therapeutic interventions are likely to come from the frontiers of molecular medicine, basic cardiovascular sciences, pharmacology, epidemiology, new diagnostic techniques, and technological advances. However, these therapies need to be tested using appropriate study designs with a special focus on timing, route of administration and co-administration of other drugs. The new approach to AHFS management will require integration and close collaboration among diverse clinical disciplines, including emergency medicine, cardiology, and critical care, as well as basic sciences and biotechnology. The working group believed that close multi-disciplinary collaboration would improve the understanding of early AHFS physiology and facilitate research that would lead to more evidence-based practices in the ED.
To advance AHFS management and improve morbidity and mortality the group recommended the following specific actions:
The proceedings of the workshop will be submitted for publication in a peer-reviewed journal.
George Sopko, MD, MPH
Monica Shah, MD, MHS, MSJ
Working Group Members
Last Updated: February 2010