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Acute heart failure in the older patient in the emergency department

Published online by Cambridge University Press:  27 November 2014

F. Javier Martín-Sánchez ,
Esther Rodríguez-Adrada  and
José Manuel Ribera Casado
F. Javier Martín-Sánchez*
Affiliation:
Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Esther Rodríguez-Adrada
Affiliation:
Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
José Manuel Ribera Casado
Affiliation:
Universidad Complutense de Madrid, Spain
*
Address for correspondence: Dr Francisco Javier Martín-Sánchez, Servicio de Urgencias, Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain. Email: fjjms@hotmail.com
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Summary

Acute heart failure is a highly prevalent geriatric syndrome presenting one of the most frequent reasons for visits to the emergency department and hospital admission, and is associated with a high morbidity and mortality and acute functional impact. The present study reviews some of the features that characterize diagnosis and immediate management of acute heart failure in older people, as well as recommendations about the management of co-morbidity, risk stratification and the decisión-making process, and the design of care plans in this older age group within the setting of hospital emergency departments.

Keywords

acute heart failureelderlyemergency department
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 4 , November 2014 , pp. 290 - 303
Copyright
Copyright © Cambridge University Press 2014 

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References

1Nieminen, MS, Harjola, VP. Definition and epidemiology of acute heart failure syndromes. Am J Cardiol 2005; 96: 5G–10G.CrossRefGoogle ScholarPubMed
2Llorens, P, Miró, O, Martín Sánchez, FJ, Herrero Puente, P, Rodríguez, JJ, Gil, V. Guidelines for emergency management of acute heart failure: consensus of the Acute Heart Failure Working Group of the Spanish Society of Emergency Medicine (AHF-SEMES) in 2011. Emergencias 2011; 23: 119–39.Google Scholar
3Kannel, WB, Belanger, AJ. Epidemiology of heart failure. Am Heart J 1991; 121: 951–57.CrossRefGoogle ScholarPubMed
4Rodríguez-Artalejo, F, Banegas, JR, Guallar-Castillón, P. Epidemiología de la insuficiencia cardíaca. Rev Esp Cardiol 2004; 57: 163–70.CrossRefGoogle Scholar
5Roger, VL, Weston, SA, Redfield, MM, Hellermann-Homan, JP, Killian, J, Yawn, BPet al.Trends in heart failure incidence and survival in a community-based population. JAMA 2004; 292: 344–50.CrossRefGoogle Scholar
6Lloyd-Jones, D, Adams, RJ, Brown, TM, Carnethon, M, Dai, S, De Simone, Get al.Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 2010; 121: e46–215.Google ScholarPubMed
7Go, AS, Mozaffarian, D, Roger, VL, Benjamin, EJ, Berry, JD, Borden, WBet al.Executive summary: heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation 2013; 127: 143–52.CrossRefGoogle ScholarPubMed
8Anguita Sánchez, M, Crespo Leiro, MG, de Teresa Galván, E, Jiménez Navarro, M, Alonso-Pulpón, L, Muñiz García, J, PRICE Study Investigators. Prevalence of heart failure in the Spanish general population aged over 45 years. The PRICE Study. Rev Esp Cardiol 2008; 61: 1041–49.CrossRefGoogle ScholarPubMed
9Martín, FJ, Herrero, P, Llorens Soriano, P, Gil, V. Epidemiología de la insuficiencia cardiaca en España: por una foto más global. Rev Esp Cardiol 2009; 62: 328–36.Google Scholar
10Bleumink, GS, Knetsch, AM, Sturkenboom, MC, Straus, SM, Hofman, A, Deckers, JWet al.Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J 2004; 25: 1614–19.CrossRefGoogle ScholarPubMed
11Gheorghiade, M, Abraham, WT, Albert, NM, Greenberg, BH, O’Connor, CM, She, Let al.Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 2006; 296: 2217–26.CrossRefGoogle ScholarPubMed
12Martín-Sánchez, FJ, Marino-Genicio, R, Rodríguez-Adrada, E, Jacob, J, Herrero, P, Miró, Oet al.Management of acute heart failure in spanish emergency departments based on age. Rev Esp Cardiol 2013; 66: 715–20.CrossRefGoogle ScholarPubMed
13Jacob, J, Martín-Sanchez, FJ, Herrero, P, Miró, O, Llorens, P. Prognostic value of troponin in patients with acute heart failure attended in Spanish Emergency Departments: TROPICA study (TROPonin in acute heart failure). Med Clin (Barc). 2013; 140: 145–51.CrossRefGoogle ScholarPubMed
14Januzzi, JL Jr, Chen-Tournoux, AA, Moe, G. Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol 2008; 101: 29–38.CrossRefGoogle ScholarPubMed
15Gaggin, HK, Januzzi, JL. Biomarkers and diagnostics in heart failure. Biochim Biophys Acta 2013; 1832: 2442–50.CrossRefGoogle ScholarPubMed
16Martín Sánchez, FJ, Covarrubias, M, Terán, C, Llorens, P, Herrero, P, Jacob, Jet al.Prognostic role of NT-proBNP in emergency department in the elderly with acute heart failure. Rev Esp Geriatr Gerontol 2013; 48: 155–60.CrossRefGoogle ScholarPubMed
17Herrero-Puente, P, Martín-Sánchez, FJ, Fernández-Fernández, M, Jacob, J, Llorens, P, Miró, Ò, Alvarez, ABet al.Differential clinical characteristics and outcome predictors of acute heart failure in elderly patients. Int J Cardiol 2012; 155: 81–86.CrossRefGoogle ScholarPubMed
18Prosen, G, Klemen, P, Štrnad, M, Grmec, S. Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting. Crit Care 2011; 15: R114CrossRefGoogle ScholarPubMed
19Jacob Rodríguez, J, Herrero Puente, P, Martín Sánchez, FJ, Llorens, P, Miró, O, Perelló, R. EAHFE (Epidemiology Acute Heart Failure Emergency) study: analysis of the patients with echocardiography performed prior to an emergency visit due to an episode of acute heart failure. Rev Clin Esp 2011; 211: 329–37.CrossRefGoogle Scholar
20Garcia Fernandez, MA. Is it possible to train non-cardiologists to perform echocardiography? Rev Esp Cardiol 2014; 67: 168–70.CrossRefGoogle ScholarPubMed
21Delerme, S, Chenevier-Gobeaux, C, Doumenc, B, Ray, P. Usefulness of B Natriuretic Peptides and procalcitonin in emergency medicine. Biomark Insights 2008; 3: 203–17.CrossRefGoogle Scholar
22Kajimoto, K, Madeen, K, Nakayama, T, Tsudo, H, Kuroda, T, Abe, T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012; 10: 49.CrossRefGoogle ScholarPubMed
23Aguirre Tejedo, A, Miró, O, Jacob Rodríguez, A, Herrero Puente, P, Martín-Sánchez, FJ, Alemany, Xet al.Papel del factor precipitante de un episodio de insuficiencia cardiaca aguda en relación al pronóstico a corto plazo del paciente: estudio PAPRICA. Emergencias 2012; 24: 438–46.Google Scholar
24Formiga, F, Chivite, D, Manito, N, Casas, S, Riera, A, Pujol, R. Predictors of in-hospital mortality present at admission among patients hospitalised because of decompensated heart failure. Cardiology 2007; 108: 73–78.CrossRefGoogle ScholarPubMed
25Sales, AE, Tipton, EF, Levine, DA, Houston, TK, Kim, Y, Allison, Jet al.Are co-morbidities associated with guideline adherence? The MI-Plus study of Medicare patients. J Gen Intern Med 2009; 24: 1205–10.CrossRefGoogle ScholarPubMed
26Forman, DE, Cannon, CP, Hernandez, AF, Liang, L, Yancy, C, Fonarow, GC. Influence of age on the management of heart failure: findings from Get With the Guidelines-Heart Failure (GWTG-HF). Am Heart J 2009; 157: 1010–17.CrossRefGoogle ScholarPubMed
27Gray, A, Goodacre, S, Newby, DE, Masson, M, Sampson, F, Nicholl, J. Non-invasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142–51.CrossRefGoogle ScholarPubMed
28Keenan, SP, Sinuff, T, Burns, KE, Muscedere, J, Kutsogiannis, J, Mehta, Set al.Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and non-invasive continuous positive airway pressure in the acute care setting. CMAJ 2011; 183: E195–214.CrossRefGoogle Scholar
29Hess, DR. Non-invasive ventilation for acute respiratory failure. Respir Care 2013; 58: 950–72.CrossRefGoogle ScholarPubMed
30Vital, FM, Ladeira, MT, Atallah, AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema.Cochrane Database Syst Rev 2013; 5: CD005351.Google Scholar
31Mariani, J, Macchia, A, Belziti, C, Deabreu, M, Gagliardi, J, Doval, Het al.Non-invasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials. J Card Fail 2011; 17: 850–59.CrossRefGoogle ScholarPubMed
32Felker, GM, Lee, KL, Bull, DA, Redfield, MM, Stevenson, LW, Goldsmith, SRet al.Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011; 364: 797–805.CrossRefGoogle ScholarPubMed
33Leto, L, Aspromonte, N, Feola, M. Efficacy and safety of loop diuretic therapy in acute decompensated heart failure: a clinical review. Heart Fail Rev 2014; 19: 237–46.CrossRefGoogle ScholarPubMed
34McMurray, JJ, Adamopoulos, S, Anker, SD, Auricchio, A, Böhm, M, Dickstein, Ket al.ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 803–69.Google Scholar
35Levy, P, Compton, S, Welch, R, Delgado, G, Jennett, A, Penugonda, Net al.Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med 2007; 50: 144–52.CrossRefGoogle ScholarPubMed
36Cotter, G, Metzkor, E, Kaluski, E, Faigenberg, Z, Miller, R, Simovitz, Aet al.Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 1998; 351: 389–93.CrossRefGoogle ScholarPubMed
37Jondeau, G, Neuder, Y, Eicher, JC, Jourdain, P, Fauveau, E, Galinier, Met al.B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J 2009; 30: 2186–92.CrossRefGoogle ScholarPubMed
38Llorens Soriano, P, Miró, O, Martín, FJ, Herrero, P. Beta-blocker treatment in elderly patients with acute heart failure in the emergency departments. Med Clin (Barc) 2011; 136: 509.CrossRefGoogle ScholarPubMed
39Metra, M, Torp-Pedersen, C, Cleland, JG, Di Lenarda, A, Komajda, M, Remme, WJet al.Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET. Eur J Heart Fail 2007; 9: 901–9.CrossRefGoogle ScholarPubMed
40Hohl, CM, Dankoff, J, Colacone, A, Afilalo, M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001; 38: 666–71.CrossRefGoogle ScholarPubMed
41Martín-Sánchez, FJ, Martínez Agüero, M, Fernández Alonso, C, González del Castillo, J, Jorge González Armengol, J. Drug-induced adverse events in elderly persons presenting to the emergency department. Gac Sanit 2012; 26: 585–86.Google ScholarPubMed
42Formiga, F, Chivite, D, Casas, S, Manito, N, Pujol, R. Functional assessment of elderly patients admitted for heart failure. Rev Esp Cardiol 2006; 59: 740–42.CrossRefGoogle ScholarPubMed
43Miró, O, Llorens, P, Martín-Sánchez, FJ, Herrero, P, Pavón, J, Pérez-Durá, MJet al.Short-term prognostic factors in elderly patients seen in emergency departments for acute heart failure. Rev Esp Cardiol 2009; 62: 757–64.CrossRefGoogle ScholarPubMed
44Ahluwalia, SC, Gross, CP, Chaudhry, SI, Leo-Summers, L, Van Ness, PH, Fried, TR. Change in comorbidity prevalence with advancing age among persons with heart failure. J Gen Intern Med 2011; 26: 1145–51.CrossRefGoogle ScholarPubMed
45Mahjoub, H, Rusinaru, D, Soulière, V, Durier, C, Peltier, M, Tribouilloy, C. Long-term survival in patients older than 80 years hospitalised for heart failure. A 5-year prospective study. Eur J Heart Fail 2008; 10: 78–84.CrossRefGoogle ScholarPubMed
46Komajda, M, Hanon, O, Hochadel, M, Lopez-Sendon, JL, Follath, F, Ponikowski, Pet al.Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J. 2009; 30: 478–86.CrossRefGoogle ScholarPubMed
47Biagi, P, Gussoni, G, Iori, I, Nardi, R, Mathieu, G, Mazzone, Aet al.Study Group. Clinical profile and predictors of in-hospital outcome in patients with heart failure: the FADOI ‘CONFINE’ Study. Int J Cardiol 2011; 152: 88–94.CrossRefGoogle Scholar
48Aaronson, KD, Schwartz, JS, Chen, TM, Wong, KL, Goin, JE, Mancini, DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997; 95: 2660–67.CrossRefGoogle ScholarPubMed
49Lee, DS, Austin, PC, Rouleau, JL, Liu, PP, Naimark, D, Tu, JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003; 290: 2581–87.CrossRefGoogle ScholarPubMed
50Fonarow, GC, Adams, KF Jr, Abraham, WT, Yancy, CW, Boscardin, WJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 2005; 293: 572–80.CrossRefGoogle Scholar
51Heywood, JT, Elatre, W, Pai, RG, Fabbri, S, Huiskes, B. Simple clinical criteria to determine the prognosis of heart failure. J Cardiovasc Pharmacol Ther 2005; 10: 173–80.CrossRefGoogle ScholarPubMed
52Levy, WC, Mozaffarian, D, Linker, DT, Sutradhar, SC, Anker, SD, Cropp, ABet al.The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 2006; 113: 1424–33.CrossRefGoogle ScholarPubMed
53Pocock, SJ, Wang, D, Pfeffer, MA, Yusuf, S, McMurray, JJ, Swedberg, KBet al.Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J 2006; 27: 65–75.CrossRefGoogle ScholarPubMed
54Nutter, AL, Tanawuttiwat, T, Silver, MA. Evaluation of 6 prognostic models used to calculate mortality rates in elderly heart failure patients with a fatal heart failure admission. Congest Heart Fail 2010; 16: 196–201.CrossRefGoogle ScholarPubMed
55Chivite, D, Formiga, F, Pujol, R. Heart failure in the elderly cardiac failure patient. Rev Clin Esp 2011; 211: 26.CrossRefGoogle Scholar
56Martín-Sánchez, FJ, Gil, V, Llorens, P, Herrero, P, Jacob, J, Fernández, Cet al.Barthel Index-Enhanced Feedback for Effective Cardiac Treatment (BI-EFFECT) Study: contribution of the Barthel Index to the Heart Failure Risk Scoring System model in elderly adults with acute heart failure in the emergency department. J Am Geriatr Soc 2012; 60: 493–98.CrossRefGoogle Scholar
57Pilotto, A, Addante, F, Franceschi, M, Leandro, G, Rengo, G, D’Ambrosio, Pet al.Multidimensional Prognostic Index based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail 2010; 3: 14–20.CrossRefGoogle ScholarPubMed
58Rodríguez-Pascual, C, Vilches-Moraga, A, Paredes-Galán, E, Ferrero-Marinez, AI, Torrente-Carballido, M, Rodríguez-Artalejo, F. Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure. Am Heart J 2012; 164: 756–62.CrossRefGoogle ScholarPubMed
59Martín-Sánchez, FJ, Fernández Alonso, C, Gil Gregorio, P. Key points in healthcare of frail elders in the emergency department. Med Clin (Barc) 2013; 140: 24–29.CrossRefGoogle ScholarPubMed
60Ezekowitz, JA, Bakal, JA, Kaul, P, Westerhout, CM, Armstrong, PW. Acute heart failure in the emergency department: short and long-term outcomes of elderly patients with heart failure. Eur J Heart Fail 2008; 10: 308–14.CrossRefGoogle Scholar
61Miró, O, Llorens, P, Martín-Sánchez, FJ, Herrero, P, Jacob, J, Pérez-Durá, MJet al.Predicting the risk of reattendance for acute heart failure patients discharged from Spanish Emergency Department observation units. Eur J Emerg Med 2010; 17: 197–202.CrossRefGoogle ScholarPubMed
62Sánchez, M, Salgado, E, Miró, O. Mecanismos organizativos de adaptación y supervivencia de los servicios de urgencia. Emergencias 2008; 20: 48–53.Google Scholar
63Peacock, WF 4th, Remer, EE, Aponte, J, Moffa, DA, Emerman, CE, Albert, NM. Effective observation unit treatment of decompensated heart failure. Congest Heart Fail 2002; 8: 68–73.CrossRefGoogle ScholarPubMed
64Martín-Sánchez, FJ, Carbajosa, V, Llorens, P, Herrero, P, Jacob, J, Pérez-Dura, MJet al.Prolonged hospitalization in patients admitted for acute heart failure in the short stay unit (EPICA-UCE study): study of associated factors. Med Clin (Barc) 2014 143: 245–51.CrossRefGoogle ScholarPubMed
65Caplan, GA, Sulaiman, NS, Mangin, DA, Aimonino Ricauda, N, Wilson, AD, Barclay, L. A meta-analysis of ‘hospital in the home’. Med J Aust 2012; 197: 512–19.CrossRefGoogle ScholarPubMed
66Esteve Arríen, A, Domínguez de Pablos, G, Minaya Saiz, J. Adherence to pharmaceutical guidance in patients over 85 years of age with chronic heart failure-stage C. Effects on 12-month mortality. Rev Esp Geriatr Gerontol 2009; 44: 90–93.CrossRefGoogle ScholarPubMed
67Fonarow, GC, Albert, NM, Curtis, AB, Stough, WG, Gheorghiade, M, Heywood, JTet al.Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). Circulation 2010; 122: 585–96.CrossRefGoogle ScholarPubMed
68Peacock, WF, Young, J, Collins, S, Diercks, D, Emerman, C. Heart failure observation units: optimizing care. Ann Emerg Med 2006; 47: 22–33.CrossRefGoogle ScholarPubMed
69Peacock, WF, Fonarow, GC; Heart Failure Diagnosis Subcommittee, Ander, DS, Maisel, A, Hollander, JEet al.Society of Chest Pain Centers Recommendations for the evaluation and management of the observation stay acute heart failure patient: a report from the Society of Chest Pain Centers Acute Heart Failure Committee. Crit Pathw Cardiol 2008; 7: 83–86.Google Scholar