Browsing by Author "Gheorghiade, Mihai"

Now showing 1 - 4 of 4
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    Acute Dyspnea and Decompensated Heart Failure
    (Elsevier, 2018-02) Pang, Peter S.; Collins, Sean P.; Gheorghiade, Mihai; Butler, Javed; Emergency Medicine, School of Medicine
    The majority of patients hospitalized with acute heart failure (AHF) initially present to the emergency department (ED). Correct diagnosis followed by prompt treatment ensures optimal outcomes. Paradoxically, identification of high risk is not the unmet need, given nearly all ED AHF patients are hospitalized; rather, it is identification of low-risk. Currently, no risk-stratification instrument can be universally recommended to safely discharge ED patients. With the exception of diagnosis, management recommendations are largely expert opinion, informed by existing evidence and tradition. In the absence of robust evidence, we propose a framework for management to guide the busy clinician.
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    Acute Heart Failure Assessment: The Role of Focused Emergency Cardiopulmonary Ultrasound in Identification and Early Management
    (Wiley, 2015-12) Ferre, Robinson M.; Chioncel, Ovidiu; Pang, Peter S.; Lang, Roberto M.; Gheorghiade, Mihai; Collins, Sean P.; Department of Emergency Medicine, IU School of Medicine
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    Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea
    (Elsevier, 2017-06) Pang, Peter S.; Lane, Kathleen A.; Tavares, Miguel; Storrow, Alan B.; Shen, Changyu; Peacock, W. Frank; Nowack, Richard; Mebazaa, Alexandre; Laribi, Said; Hollander, Judd E.; Gheorghiade, Mihai; Collins, Sean P.; Emergency Medicine, School of Medicine
    Background Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established. Methods We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard (‘minimally improved or worse’). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale (‘minimally worse’, ‘no change’, or ‘minimally better’). Results Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale. Conclusion A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF.
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    Predictors of Post-discharge Mortality Among Patients Hospitalized for Acute Heart Failure
    (Radcliffe Cardiology, 2017-11) Chioncel, Ovidiu; Collins, Sean P.; Greene, Stephen J.; Pang, Peter S.; Ambrosy, Andrew P.; Antohi, Elena-Laura; Vaduganathan, Muthiah; Butler, Javed; Gheorghiade, Mihai; Emergency Medicine, School of Medicine
    Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease. From the perspective of care providers, it may facilitate management decisions, such as who needs to be admitted and to what level of care (i.e. floor, step-down, ICU). Furthermore, risk-stratification may help identify patients who need to be evaluated for advanced HF therapies (i.e. left-ventricle assistance device or transplant or palliative care), and patients who need early a post-discharge follow-up plan. Finally, risk stratification will allow for more robust efforts to identify among risk markers the true targets for therapies that may direct treatment strategies to selected high-risk patients. Further clinical research will be needed to evaluate if appropriate risk stratification of patients could improve clinical outcome and resources allocation.