Esem17 ppt 16x9
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- 1. Al Yaqdhan Al Atbi Sultanate of Oman
- 2. Summarizing the study Results Applicability of the study Conclusion
- 3. Recent HF guidelines and recommendations emphasized the importance of immediate diagnosis and treatment of patients presenting with AHF. (Ponikowski P, et al; 2016) A delay in initiating heart failure therapy was associated with modestly higher risk for in-hospital mortality and longer length of stay. (Wong YW et al 2013) (Maisel AS et al, 2008)
- 4. In patients with AHF, the efficacy of any treatment may be time-dependent. (Mebazaa A, et al; 2010) (Peacock WF, et al; 2009)
- 5. To determine the prognostic impact of time to treatments for AHF performed in the acute phase. Evaluated the association between time-to- diuretic treatment and clinical outcome
- 6. Prospective, multicenter, observational cohort study Study period: August 2014 to December 2015 Study sites: 20 participating hospitals
- 7. Eligible participants AHFS patients who are admitted via emergency department. The AHFS is diagnosed according to Framingham criteria. Over 20 years old. AHFS was diagnosed within 3 hours after arriving to ED and physical exam was taken by medical staff
- 8. Exclusion criteria were: Treatment with an IV drug before ED arrival. Previous heart transplantation. On either chronic peritoneal dialysis or hemodialysis Acute myocarditis. BNP level < 100 pg/mL or N-terminal-proBNP level < 300 pg/mL at baseline. Acute coronary syndrome require emergent revascularization.
- 9. Early D2F: 60 minutes In-hospital mortality
- 10. The Get With the Guidelines-Heart Failure (GWTG-HF) risk score: Assess the risk of in-hospital mortality in patients with acute heart failure The component of the score: - Systolic BP - BUN - Sodium - Age - Heart Rate- Black race - COPD history
- 11. GWTG-HF risk score
- 12. Prospective and multicenter study No patient was lost to follow-up for in-hospital outcome. Good sample size.
- 13. Cohort study Type I error: GWTG-HF risk score was slightly lower in the early treatment group No data about the cause of HF exacerbation. Association between D2F time and long-term prognosis
- 14. Patients with AHF and prominent congestive symptoms were more likely to be treated early with IV furosemide Treatment with IV furosemide within 60 min was independently associated with better in-hospital Survival
- 15. This study confirms the association between in-hospital mortality and the time of initiating IV diuretics. Based on current evidence, acute heart failure therapy should be initiated as soon as the diagnosis is established.
- 16. IN ACUE HEART FAILURE:
- 17. Mebazaa A, Pang PS, Tavares M, et al. The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENTdyspnoea study. Eur Heart J 2010;31:83241. Maisel AS, Peacock WF, McMullin N, 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;52:53440. Peacock WF, Emerman C, Costanzo MR, Diercks DB, Lopatin M, Fonarow GC. Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail 2009;15:25664. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016;18:891975. GWTG-Heart Failure Risk Score - MDCalc [Internet]. [cited 2017 Dec 5]. Available from: https://www.mdcalc.com/gwtg- heart-failure-risk-score#evidence