title: Hemodynamic profiles of ED patients with acute decompensated heart failure and their association with treatment.
abstract: BACKGROUND
  The hemodynamic profile of patients presenting to the emergency department (ED) with acutely decompensated heart failure (ADHF) provides the basis for initial management. We characterized the hemodynamic profiles of patients presenting to the ED with ADHF and their association with treatments and outcomes.
  
  
  METHODS
  We conducted a retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2006-2010) including ED subjects presenting with ADHF. Patients were classified into 3 groups based on their presenting systolic blood pressure (SBP): hypertensive (HTN) (SBP, ≥ 160), normotensive (NT) (SBP, 100-159), or hypotensive (HYPO) (SBP, <100). Univariate and multivariate analyses were used to determine associations between age, sex, race, and medications administered vs hemodynamic profiles using χ(2) test and logistic regression.
  
  
  RESULTS
  There were an estimated 3.4 million ED patient visits for ADHF. Mean age was 69 years, 51% were men, and 65% were white. Hemodynamic profiles at presentation were HTN (32%), NT (48%), and HYPO (21%). Age, sex, and ethnicity were similar across hemodynamic profiles. Rates of admission (HTN [78%], NT [75%], and HYPO [72%]; P = .39) and ED mortality (HYPO, 0.8%; HTN and HYPO, 0% each; P = .12) were not associated with hemodynamic group. Although administration of loop diuretics was similar across groups (approximately 60%-70% each), vasodilator use (mostly nitroglycerin) was greatest in the HTN group (42%, HTN; 23%, NT; 12%, HYPO; P < .001).
  
  
  CONCLUSIONS
  Of HTN ADHF patients, less than half received vasodilators, and approximately one-third did not receive diuretics, in the ED. The development of stratified protocols for therapy based on these profiles should be considered.
authors.affiliation: Departments of Emergency Medicine and Cardiology, Stony Brook University, Stony Brook, NY, USA. Electronic address: adam.singer@stonybrookmedicine.edu.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.affiliation: Departments of Emergency Medicine and Cardiology, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Hal
authors.initials: H
authors.lastname: Skopicki
authors.affiliation: Departments of Emergency Medicine and Cardiology, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Thode
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
mesh_terms: D000208:Acute Disease; D000368:Aged; D003625:Data Collection / Q000379:methods; D004232:Diuretics / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D014665:Vasodilator Agents