Effect of Emergency Department Care Bundle on Elderly Patients With Acute Heart Failure

To the Editor The ELISABETH trial by Dr Freund and colleagues implemented an early guideline-recommended care bundle in the emergency department for older patients to reduce the delay to treatment and to promptly manage precipitating factors of acute heart failure. Although frontline physicians use clinical symptoms, laboratory values, and radiographic findings to make the diagnosis of acute heart failure, accurate judgment about cardiac preload and intravascular volume status remains difficult in patients with obesity, chronic venous stasis, underlying kidney dysfunction, or pulmonary disorders. A common cause for faulty assessment of cardiac preload, particularly in older patients, is discordance between right and left ventricular pressures, or right-to-left mismatch. Integrating quantitative and real-time hemodynamic measurements (eg, bedside Doppler echocardiography) for the titration of volume therapy will likely become a prerequisite in future clinical trials for acute heart failure treatment.
Source: JAMA - Category: General Medicine Source Type: research