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Prehospital heart failure

Pia Harjola, James Boyd, Tuukka Tarvasmäki, Juho Mattila, Reijo Koski, Markku Kuisma, Veli-Pekka Harjola
BACKGROUND: Real-life data on the role of emergency medical services (EMS) in acute heart failure (AHF) are scarce. Our aim was to describe prehospital treatment of AHF and to compare patients using EMS with self-presented, non-EMS patients. METHODS: Data were collected retrospectively from three university hospitals in Helsinki metropolitan area between July 1, 2012 and July 31, 2013. According to the use of EMS, patients were divided into EMS and non-EMS groups...
January 4, 2017: International Journal of Cardiology
David R Buys, Anthony D Campbell, Alice Godfryd, Kellie Flood, Elizabeth Kitchin, Meredith L Kilgore, Sally Allocca, Julie L Locher
BACKGROUND: After older adults experience episodes of poor health or are hospitalized, they may not return to premorbid or prehospitalization eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited. OBJECTIVE: This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program...
January 5, 2017: Journal of the Academy of Nutrition and Dietetics
Laura Cluzol, Jennifer Cautela, Pierre Michelet, Antoine Roch, François Kerbaul, Julien Mancini, Marc Laine, Michael Peyrol, Floriane Robin, Franck Paganelli, Laurent Bonello, Franck Thuny
BACKGROUND: Acute heart failure (AHF) is a life-threatening medical emergency for which no new effective therapies have emerged in recent decades. No previous study has exhaustively described the entire course of care of AHF patients from first medical contact to hospital discharge or assessed its impact on prognosis. AIM: To fully describe the course of care and analyze its influence on outcomes in patients hospitalized with an AHF syndrome in an academic university center...
September 29, 2016: Archives of Cardiovascular Diseases
Anne Maree Kelly, Anna Holdgate, Gerben Keijzers, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Charles Lawoko, Said Laribi
BACKGROUND: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. METHODS: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance...
September 22, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Hiroyuki Nakajima, Jiro Yoshioka, Nobuyuki Totsuka, Izumi Miyazawa, Tatsuya Usui, Nobuyuki Urasawa, Takahiro Kobayashi, Tomoaki Mochidome
BACKGROUND: Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI. DESIGN: Single-center, observational, and retrospective cohort study. METHODS: Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare...
2016: Clinical Interventions in Aging
Thomas R Scaggs, David M Glass, Megan Gleason Hutchcraft, William B Weir
Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics)...
October 2016: Prehospital and Disaster Medicine
Kristoffer Wibring, Johan Herlitz, Lennart Christensson, Markus Lingman, Angela Bång
BACKGROUND: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC). AIM: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain. METHODS: Several databases were searched for relevant articles...
September 15, 2016: International Journal of Cardiology
Brit J Long, Luis A Serrano, Jose G Cabanas, M Fernanda Bellolio
UNLABELLED: Introduction Emergency Medical Service (EMS) systems are vital in the identification, assessment, and treatment of trauma, stroke, myocardial infarction, and sepsis patients, improving early recognition, resuscitation, and transport. Emergency Medical Service personnel provide similar care for patients with syncope. The role of EMS in the management of patients with syncope has not been reported. Hypothesis/Objective The objective of this study was to describe the management of out-of-hospital syncope by prehospital providers in an urban EMS system...
August 2016: Prehospital and Disaster Medicine
Christopher B Fordyce, John A Cairns, Joel Singer, Terry Lee, Julie E Park, Richard A Vandegriend, Michele Perry, Wendy Largy, Min Gao, Krishnan Ramanathan, Graham C Wong
BACKGROUND: We describe the evolution of a regional system designed to provide primary percutaneous coronary intervention (pPCI) as the preferred method of revascularization for ST-elevation myocardial infarction (STEMI) and its impact on first medical contact (FMC)-to-device times and in-hospital outcomes. METHODS: Patients with STEMI presenting to the Vancouver Coastal Health Authority between June 2007 and January 2015 (N = 2503) were categorized according to 3 sequential phases: phase 1 = standardization of reperfusion algorithms; phase 2 = use of prehospital electrocardiograms; phase 3 = expedited interfacility transfer for pPCI...
December 19, 2015: Canadian Journal of Cardiology
I Ben Ali, W Jomaa, S Hamdi, A Elhraiech, M Azaiez, K Ben Hamda, F Maatouk
BACKGOUND: Patients with hypertension (HTN) presenting with acute myocardial infarction (AMI) are at high risk of major cardiac events in the hospital course. On the other hand, renal failure on admission (RF) is common in this population. We aimed to study the impact of renal failure on admission on in-hospital mortality in patients with HTN presenting with AMI. METHODS: We reviewed data from a retrospective registry including 1498 patients presenting to our center for AMI from January 1998 to November 2014...
December 2015: Annales de Cardiologie et D'angéiologie
Daniel J Johnson, Andrew V Scott, Viachaslau M Barodka, Sunhee Park, Jack O Wasey, Paul M Ness, Tom Gniadek, Steven M Frank
BACKGROUND: It is well recognized that increased transfusion volumes are associated with increased morbidity and mortality, but dose-response relations between high- and very-high-dose transfusion and clinical outcomes have not been described previously. In this study, the authors assessed (1) the dose-response relation over a wide range of transfusion volumes for morbidity and mortality and (2) other clinical predictors of adverse outcomes. METHODS: The authors retrospectively analyzed electronic medical records for 272,592 medical and surgical patients (excluding those with hematologic malignancies), 3,523 of whom received transfusion (10 or greater erythrocyte units throughout the hospital stay), to create dose-response curves for transfusion volumes and in-hospital morbidity and mortality...
February 2016: Anesthesiology
David R Thickett, Takuhiro Moromizato, Augusto A Litonjua, Karin Amrein, Sadeq A Quraishi, Kathleen A Lee-Sarwar, Kris M Mogensen, Steven W Purtle, Fiona K Gibbons, Carlos A Camargo, Edward Giovannucci, Kenneth B Christopher
OBJECTIVE: We hypothesise that low 25-hydroxyvitamin D (25(OH)D) levels before hospitalisation are associated with increased risk of acute respiratory failure. DESIGN: Retrospective cohort study. SETTING: Medical and Surgical Intensive care units of two Boston teaching hospitals. PATIENTS: 1985 critically ill adults admitted between 1998 and 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure of interest was prehospital serum 25(OH)D categorised as ≤10 ng/mL, 11-19...
2015: BMJ Open Respiratory Research
Jaewon Oh, Seok-Min Kang, Mi Kyung Song, Namki Hong, Jong-Chan Youn, Seongwoo Han, Eun-Seok Jeon, Myeong-Chan Cho, Jae-Joong Kim, Byung-Su Yoo, Shung Chull Chae, Byung-Hee Oh, Dong-Ju Choi, Myung-Mook Lee, Kyu-Hyung Ryu
BACKGROUNDS: We investigated the relationship between spironolactone use and all-cause mortality in acute decompensated heart failure (ADHF) patients with severe renal dysfunction. The clinical benefit of spironolactone in the treatment of heart failure (HF) has been described in several large randomized clinical trials. However, its clinical benefits have not been studied in hospitalized ADHF patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] <45 mL/min per 1...
May 2015: American Heart Journal
L Celeste Nieves, Gia M Mehrtens, Noah Pores, Christie Pickrell, James Tanis, Timothy Satty, Michelle Chuang, Tina C Young, Mark A Merlin
BACKGROUND: The most effective dose of prehospital furosemide in acute decompensated heart failure (ADHF) has not yet been identified and concerns of worsening renal function have limited its use. OBJECTIVE: To assess if administering high-dose furosemide is associated with worsening renal function. METHODS: The authors conducted a 2-center chart review for patients who presented via a single Emergency Medical Service (EMS) from June 5, 2009 through May 17, 2013...
February 2015: Prehospital and Disaster Medicine
Mikkel Malby Schoos, Maria Sejersten, Usman Baber, Philip Michael Treschow, Mette Madsen, Anders Hvelplund, Henning Kelbæk, Roxana Mehran, Peter Clemmensen
Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials and registries are subject to selection biases. We aimed to describe the prevalence and prognosis of acute CV disease and the effect of invasive treatment, in an unselected and consecutive prehospital cohort of 3,410 patients calling the national emergency telephone number from 2005 to 2008 with follow-up in 2013...
January 1, 2015: American Journal of Cardiology
Laetitia Yperzeele, Robbert-Jan Van Hooff, Ann De Smedt, Alexis Valenzuela Espinoza, Rita Van Dyck, Rohny Van de Casseye, Andre Convents, Ives Hubloue, Door Lauwaert, Jacques De Keyser, Raf Brouns
BACKGROUND: Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation. METHODS: A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification...
2014: PloS One
Matej Strnad, Gregor Prosen, Vesna Borovnik Lesjak
OBJECTIVE: The aim of this pilot study was to determine the usefulness of prehospital lung ultrasound in monitoring the effectiveness of treatment with continuous positive airway pressure (CPAP) versus standard therapy in patients with acute decompensated heart failure (ADHF). MATERIALS AND METHODS: Twenty patients with ADHF were enrolled in this prospective, observational study. They were allocated randomly to a CPAP group (CPAP and standard therapy) or a control group (standard therapy only)...
February 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Mohammad Al Deeb, Skye Barbic, Robin Featherstone, Jerrald Dankoff, David Barbic
OBJECTIVES: Acute dyspnea is a common presenting complaint to the emergency department (ED), and point-of-care (POC) lung ultrasound (US) has shown promise as a diagnostic tool in this setting. The primary objective of this systematic review was to determine the sensitivity and specificity of US using B-lines in diagnosing acute cardiogenic pulmonary edema (ACPE) in patients presenting to the ED with acute dyspnea. METHODS: A systematic review protocol adhering to Cochrane Handbook guidelines was created to guide the search and analysis, and we searched the following databases: PubMed, EMBASE, Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, and the Cochrane Database of Systematic Reviews...
August 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jihong Li, Spandana Vootukuri, Yi Shang, Ana Negri, Jian-Kang Jiang, Mark Nedelman, Thomas G Diacovo, Marta Filizola, Craig J Thomas, Barry S Coller
OBJECTIVE: Treatment of myocardial infarction within the first 1 to 2 hours with a thrombolytic agent, percutaneous coronary intervention, or an αIIbβ3 antagonist decreases mortality and the later development of heart failure. We previously reported on a novel small molecule αIIbβ3 antagonist, RUC-2, that has a unique mechanism of action. We have now developed a more potent and more soluble congener of RUC-2, RUC-4, designed to be easily administered intramuscularly by autoinjector to facilitate its use in the prehospital setting...
October 2014: Arteriosclerosis, Thrombosis, and Vascular Biology
Christopher L Hunter, Salvatore Silvestri, George Ralls, Linda Papa
BACKGROUND: Differentiating between cardiac and obstructive causes for dyspnoea is essential for proper management, but is difficult in the prehospital setting. OBJECTIVE: To assess if prehospital levels of end-tidal carbon dioxide (ETCO2) differed in obstructive compared to cardiac causes of dyspnoea, and could suggest one diagnosis over the other. METHODS: We conducted a retrospective cohort study among patients transported by emergency medical services during a 29-month period who were diagnosed with either obstructive pulmonary disease or congestive heart failure (CHF) by ICD-9 codes...
June 2015: Emergency Medicine Journal: EMJ
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