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Current Heart Failure Reports

, Volume 16, Issue 1, pp 12–20 | Cite as

Early Treatment in Emergency Department Patients with Acute Heart Failure: Does Time Matter?

  • Anna Marie ChangEmail author
  • Peter S. Pang
  • Javed Butler
  • Alan B. Storrow
  • Phillip D. Levy
  • JoAnn Lindenfeld
  • Sean P. Collins
Emergency Medicine (F Peacock, Section Editor)
  • 67 Downloads
Part of the following topical collections:
  1. Topical Collection on Emergency Medicine

Abstract

Purpose of Review

Acute heart failure accounts for over one million hospital discharges annually. Current guidelines suggest treatments for AHF should begin “without delay” but this time interval has not been clearly defined.

Recent Findings

Data suggest that certain treatments such as earlier treatment with diuretics and vasodilators may improve patient symptom relief, morbidity, and mortality. Secondary analyses of clinical trials of novel treatments under development have not shown similar results.

Summary

The data are equivocal regarding the impact of early treatment in AHF on in-hospital and long-term morbidity and mortality. Improved clinical trial designs will help answer when and if “early” treatment should begin and whether it impacts short- and long-term outcomes in AHF.

Keywords

Acute heart failure Emergency medicine Treatments for AHF 

Notes

Compliance with Ethical Standards

Conflict of Interest

Alan Storrow: Consultant for Quiedel, Siemens, Novartis. Grant support from NIH, AHRQ, and PCORI.

Sean Collins: Consulting- Medtronic, Novartis, Ortho Clinical, Vixiar. Research support - NIH, PCORI, AHRQ, AHA.

Peter Pang: Consultant for: Baxter, BMS, Novartis. And has received research or other support from: BMS, Roche, Novartis, PCORI, AHA, NHLBI, AHRQ, OrthoDiagnostics, Abbott.

Phillip Levy: Consultant for: Apex Innovations, Astra Zeneca, Mespere, Novartis, Ortho Diagnostics, Roche Diagnostics, Veravas, Shire, Siemens, Hospital Quality Foundation. Research Support: Amgen, Arterez, Beckman Coulter, AHRQ, BCBSMF, EMF, MDHHS, PCORI, NIH/NIMHD, NIH/NHLBI.

Javed Butler has received research support from the NIH and European Union, and has served as a consultant to Amgen, Astra-Zeneca, Bayer, Boehringer Ingelheim, BMS, CVRx, Janssen, Medtronic, Merck, Novartis, Relypsa and Vifor.

Anna Marie Chang: research support: Beckman Coulter, Bristol Meyers Squibb, Ortho Clinical Diagnostics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Storrow AB, Jenkins CA, Self WH, Alexander PT, Barrett TW, Han JH, et al. The burden of acute heart failure on U.S. emergency departments. JACC Heart Fail. 2014;2(3):269–77.  https://doi.org/10.1016/j.jchf.2014.01.006.CrossRefGoogle Scholar
  2. 2.
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, Subcommittee On behalf of the AHASC and SS. Heart Disease and Stroke Statistics—2017 Update: a report from the American Heart Association. Circulation. 2017;CIR.0000000000000485.  https://doi.org/10.1161/CIR.0000000000000485.
  3. 3.
    Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209–16.  https://doi.org/10.1016/j.ahj.2004.08.005.CrossRefGoogle Scholar
  4. 4.
    Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States. Circ Heart Fail. 2013;6(3):606–19.  https://doi.org/10.1161/HHF.0b013e318291329a.CrossRefGoogle Scholar
  5. 5.
    Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola V-P, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725–36.  https://doi.org/10.1093/eurheartj/ehl193.CrossRefGoogle Scholar
  6. 6.
    Peacock WF, Emerman C, Costanzo MR, Diercks DB, Lopatin M, Fonarow GC. Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail. 2009;15(6):256–64.  https://doi.org/10.1111/j.1751-7133.2009.00112.x.CrossRefGoogle Scholar
  7. 7.
    Alexander P, Alkhawam L, Curry J, Levy P, Pang PS, Storrow AB, et al. Lack of evidence for intravenous vasodilators in ED patients with acute heart failure: a systematic review. Am J Emerg Med. 2015;33(2):133–41.  https://doi.org/10.1016/j.ajem.2014.09.009.CrossRefGoogle Scholar
  8. 8.
    Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144–52.  https://doi.org/10.1016/j.annemergmed.2007.02.022.CrossRefGoogle Scholar
  9. 9.
    Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, et al. OPTIMIZE-HF Investigators and Coordinators for the. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296(18):2217.  https://doi.org/10.1001/jama.296.18.2217.CrossRefGoogle Scholar
  10. 10.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240–327.  https://doi.org/10.1161/CIR.0b013e31829e8776.Google Scholar
  11. 11.
    Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944–56.  https://doi.org/10.1001/jama.294.15.1944.CrossRefGoogle Scholar
  12. 12.
    Teerlink JR, Metra M, Felker GM, Ponikowski P, Voors AA, Weatherley BD, et al. Relaxin for the treatment of patients with acute heart failure (Pre-RELAX-AHF): a multicentre, randomised, placebo-controlled, parallel-group, dose-finding phase IIb study. Lancet. 2009;373(9673):1429–39.  https://doi.org/10.1016/S0140-6736(09)60622-X.CrossRefGoogle Scholar
  13. 13.
    Maisel AS, Peacock WF, McMullin N, Jessie R, Fonarow GC, Wynne J, et al. Timing of Immunoreactive B-type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis. J Am Coll Cardiol. 2008;52(7):534–40.  https://doi.org/10.1016/j.jacc.2008.05.010.CrossRefGoogle Scholar
  14. 14.
    Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial. Eur Heart J. 2013;34(11):835–43.  https://doi.org/10.1093/eurheartj/ehs444.CrossRefGoogle Scholar
  15. 15.
    Matsue Y, Damman K, Voors AA, Kagiyama N, Yamaguchi T, Kuroda S, et al. Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure. J Am Coll Cardiol. 2017;69(25):3042–51.  https://doi.org/10.1016/j.jacc.2017.04.042.CrossRefGoogle Scholar
  16. 16.
    Park JJ, Kim S-H, Oh I-Y, Choi D-J, Park H-A, Cho H-J, et al. The effect of door-to-diuretic time on clinical outcomes in patients with acute heart failure. JACC Heart Fail. 2018;6(4):286–94.  https://doi.org/10.1016/j.jchf.2017.12.017.CrossRefGoogle Scholar
  17. 17.
    McMurray JJV, Teerlink JR, Cotter G, Bourge RC, Cleland JGF, Jondeau G, et al. Effects of tezosentan on symptoms and clinical outcomes in patients with acute heart failure: the VERITAS randomized controlled trials. JAMA. 2007;298(17):2009.  https://doi.org/10.1001/jama.298.17.2009.CrossRefGoogle Scholar
  18. 18.
    Massie BM, O’Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, et al. Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure. N Engl J Med. 2010;363(15):1419–28.  https://doi.org/10.1056/NEJMoa0912613.CrossRefGoogle Scholar
  19. 19.
    O’Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32–43.  https://doi.org/10.1056/NEJMoa1100171.CrossRefGoogle Scholar
  20. 20.
    Packer M, Holcomb R, Abraham WT, Anker S, Dickstein K, Filippatos G, et al. Rationale for and design of the TRUE-AHF trial: the effects of ularitide on the short-term clinical course and long-term mortality of patients with acute heart failure. Eur J Heart Fail. 2017;19(5):673–81.  https://doi.org/10.1002/ejhf.698.CrossRefGoogle Scholar
  21. 21.
    Pang PS, Butler J, Collins SP, Cotter G, Davison BA, Ezekowitz JA, et al. Biased ligand of the angiotensin II type 1 receptor in patients with acute heart failure: a randomized, double-blind, placebo-controlled, phase IIB, dose ranging trial (BLAST-AHF). Eur Heart J. 2017;38(30):2364–73.  https://doi.org/10.1093/eurheartj/ehx196.CrossRefGoogle Scholar
  22. 22.
    Peacock WF, Chandra A, Char D, Collins S, Der Sahakian G, Ding L, et al. Clevidipine in acute heart failure: results of the A study of blood pressure control in acute heart failure—a pilot study (PRONTO). Am Heart J. 2014;167(4):529–36.  https://doi.org/10.1016/j.ahj.2013.12.023.CrossRefGoogle Scholar
  23. 23.
    Martindale JL, Wakai A, Collins SP, Levy PD, Diercks D, Hiestand BC, et al. Diagnosing acute heart failure in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2016;23(3):223–42.  https://doi.org/10.1111/acem.12878.CrossRefGoogle Scholar
  24. 24.
    Lala A, McNulty SE, Mentz RJ, Dunlay S, Vader JM, AbouEzzeddine OF, et al. Relief and recurrence of congestion during and after hospitalization for acute heart failure: insights from DOSE-AHF and CARRESS-HF. Circ Heart Fail. 2015;8(4):741–8.  https://doi.org/10.1161/CIRCHEARTFAILURE.114.001957.CrossRefGoogle Scholar
  25. 25.
    Mebazaa A, Pang PS, Tavares M, Collins SP, Storrow AB, Laribi S, et al. The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study. Eur Heart J. 2010;31(7):832–41.  https://doi.org/10.1093/eurheartj/ehp458.CrossRefGoogle Scholar
  26. 26.
    Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. 2008;359(2):142–51.  https://doi.org/10.1056/NEJMoa0707992.CrossRefGoogle Scholar
  27. 27.
    Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797–805.  https://doi.org/10.1056/NEJMoa1005419.CrossRefGoogle Scholar
  28. 28.
    Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial. JAMA. 2007;297(17):1883.  https://doi.org/10.1001/jama.297.17.1883.CrossRefGoogle Scholar
  29. 29.
    Wong YW, Mentz RJ, Felker GM, Ezekowitz J, Pieper K, Heizer G, et al. Nesiritide in patients hospitalized for acute heart failure: does timing matter? Implication for future acute heart failure trials. Eur J Heart Fail. 2016;18(6):684–92.  https://doi.org/10.1002/ejhf.487.CrossRefGoogle Scholar
  30. 30.
    Chen HH, Anstrom KJ, Givertz MM, Stevenson LW, Semigran MJ, Goldsmith SR, et al. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA. 2013;310(23):2533–43.  https://doi.org/10.1001/jama.2013.282190.CrossRefGoogle Scholar
  31. 31.
    Metra M, O’Connor CM, Davison BA, Cleland JGF, Ponikowski P, Teerlink JR, et al. Early dyspnoea relief in acute heart failure: prevalence, association with mortality, and effect of rolofylline in the PROTECT study. Eur Heart J. 2011;32(12):1519–34.  https://doi.org/10.1093/eurheartj/ehr042.CrossRefGoogle Scholar
  32. 32.
    Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet. 2013;381(9860):29–39.  https://doi.org/10.1016/S0140-6736(12)61855-8.CrossRefGoogle Scholar
  33. 33.
    Efficacy, safety and tolerability of serelaxin when added to standard therapy in AHF - study results - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/results/NCT01870778. Accessed July 24, 2018.
  34. 34.
    Zile MR, Bennett TD, St John Sutton M, Cho YK, Adamson PB, Aaron MF, et al. Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation. 2008;118(14):1433–41.  https://doi.org/10.1161/CIRCULATIONAHA.108.783910.CrossRefGoogle Scholar
  35. 35.
    Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, et 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(9100):389–93.  https://doi.org/10.1016/S0140-6736(97)08417-1.CrossRefGoogle Scholar
  36. 36.
    Packer M, O’Connor C, McMurray JJV, Wittes J, Abraham WT, Anker SD, et al. Effect of ularitide on cardiovascular mortality in acute heart failure. N Engl J Med. 2017;376(20):1956–64.  https://doi.org/10.1056/NEJMoa1601895.CrossRefGoogle Scholar
  37. 37.
    Butler J, Anstrom KJ, Felker GM, Givertz MM, Kalogeropoulos AP, Konstam MA, et al. Efficacy and safety of spironolactone in acute heart failure: the ATHENA-HF randomized clinical trial. JAMA Cardiol. 2017;2(9):950–8.  https://doi.org/10.1001/jamacardio.2017.2198.CrossRefGoogle Scholar
  38. 38.
    Hamo CE, Gheorghiade M, Butler J. Novel endpoints for heart failure clinical trials. Curr Heart Fail Rep. 2017;14(4):210–6.  https://doi.org/10.1007/s11897-017-0334-z.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Anna Marie Chang
    • 1
    Email author
  • Peter S. Pang
    • 2
  • Javed Butler
    • 3
  • Alan B. Storrow
    • 4
  • Phillip D. Levy
    • 5
  • JoAnn Lindenfeld
    • 6
  • Sean P. Collins
    • 4
  1. 1.Department of Emergency MedicineThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Department of Emergency MedicineIndiana UniversityIndianapolisUSA
  3. 3.Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA
  4. 4.Department of Emergency MedicineVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of Emergency MedicineWayne State UniversityDetroitUSA
  6. 6.Department of Medicine, Division of CardiologyVanderbilt University Medical CenterNashvilleUSA

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