News:Diagnosing Heart Failure in the Emergency Department

September 24, 2007 By Grendel Burrell [mailto:grendel.burrell@gmail.com]

To assess the performance characteristics of the S3 heart sound in the ED evaluation of patients presenting with acute dyspnea, Dr. Frank Peacock et al designed and executed a multicenter prospective study of patients presenting to the ED with a primary complaint of dyspnea, the HEart failure and AUDICOR technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) study. 1077 patients met all entry criteria for the study.

45% of patients were female and 48% were black. There were high rates of concomitant disease: 20% had asthma, 28% emphysema, 34% were diabetic, 43% had a known diagnosis of CHF, 19% had prior MI, and 11% had CVA. 93% underwent chest x-ray and the results were read as “normal” in 22%. 40% of patients had cardiomegaly by x-ray. 26% of patients had an echocardiogram that was read as normal (34%), systolic dysfunction (41%), diastolic dysfunction (11%), both systolic/diastolic dysfunction (6%).

Within 15 minutes of presentation to the ED with acute dyspnea, a blinded S3 was obtained using acoustic cardiography with AUDICOR® (Inovise Medical, Portland, OR). Patients also had BNP assessed by the Biosite point of care device (Triage® BNP). At the time the AUDICOR® reading was obtained, physicians were required to indicate a diagnosis using all available data. The BNP level and S3 by acoustic cardiography were compared to a final diagnosis at the end of hospitalization, adjudicated by 2 cardiologists blinded to the S3 data.

In this large, multicenter study, the sensitivity and specificity of the S3 for heart failure diagnosis were 38% and 90%, respectively. This compared to a BNP level > 100pg/mL, which in this study had a sensitivity and specificity of 98% and 71%, respectively. Commenting on the results of the study presented as a poster at HFSA 2007, Dr. Frank Peacock, HEARD-IT investigator, Department of Emergency Medicine, The Cleveland Clinic, stated, “This technology demonstrated better assessment of an important diagnostic sign that can be missed by many physicians. This sound is a hallmark of heart failure and when present, can change how we treat patients. This approach to rapid diagnosis may improve care for patients with suspected heart failure in the emergency department.”

References:


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