Title: B-lines Lung Ultrasound Guided ED Management of Acute Heart Failure (BLUSHED-AHF) ABSTRACT Nearly 80% of acute heart failure (AHF) patients admitted to the hospital are initially treated in the emergency department (ED). Once admitted, within 30 days post-discharge, 27% of patients are re-hospitalized or die. Attempts to improve outcomes with novel therapies have all failed. The evidence for existing AHF therapies are poor: No currently used AHF treatment is known to improve outcomes. ED treatment is largely the same today as 40 years ago. Congestion, such as difficulty breathing, weight gain, and leg swelling, is the primary reason why patients present to the hospital for AHF. Treating congestion is the cornerstone of AHF management. Yet half of all AHF patients leave the hospital inadequately decongested. We propose a novel approach to aggressively decongest patients in the ED setting: lung ultrasound guided, protocol driven, AHF management. LUS B-lines are a measure of extra-vascular lung water (EVLW). In the setting of AHF, LUS are a measure of congestion. This simple, easily learned technique has excellent reliability and reproducibility. We hypothesize that a strategy-of-care will outperform usual care. At the present time, usual care is largely empirical. This study will improve the evidence base for ED AHF management. This proposed pilot study, if successful, will lead to an outcome trial examining whether an ED AHF strategy-of-care increases days alive and out of the hospital for patients.
Congestion is the primary reason why over one million Americans are hospitalized for acute heart failure (AHF) every year: Within 30 days, over 25% are dead or are re-hospitalized. These patients initially present to emergency departments (ED), yet they are treated with essentially the same medications as 40 years ago. We propose a new approach to ED AHF management: a strategy-of-care ? lung ultrasound guided, protocol driven care ? will lead to improved outcomes.
| Huston, Jessica H; Ferre, Robinson; Pang, Peter S et al. (2018) Optimal Endpoints of Acute Heart Failure Therapy. Am J Ther 25:e465-e474 |
| Russell, Frances M; Ehrman, Robert R; Ferre, Robinson et al. (2018) Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial. Heart Lung : |
| Pang, Peter S; Collins, Sean P; Butler, Javed et al. (2018) Mihai Gheorghiade, MD-Life and Concepts. Am J Ther 25:e453-e455 |
