title: Noninvasive hemodynamic monitoring in emergency patients with suspected heart failure, sepsis and stroke: the PREMIUM registry.
abstract: BACKGROUND
  Noninvasive hemodynamic (HD) assessments in the emergency department (ED) might assist in the diagnosis, therapeutic plan development and risk stratification of acutely ill patients. This multinational observational study was designed to initiate noninvasive HD measurements prior to any ED patient therapeutic interventions and broadly evaluate them for potential diagnostic, therapeutic and predictive value.
  
  
  METHODS
  We enrolled patients with suspected acute heart failure (AHF), sepsis or stroke. Continuous noninvasive HD monitoring was begun using the Nexfin finger cuff device (Edwards LifeSciences, BMEYE, Amsterdam, Netherlands). Beat-to-beat HD measurements were averaged for the initial 15 minutes, prior to therapeutic intervention. We performed suspected disease group comparisons and evaluated HD predictors of 30-day mortality.
  
  
  RESULTS
  Of 510 patients enrolled: 185 (36%) AHF, 194 (38%) sepsis and 131 (26%) stroke. HD variables were significantly different (p<0.05) amongst the groups. Cardiac output and index and stroke volume index (SVI) were highest in sepsis (6.5, 3.5, 36), followed by stroke (5.5, 2.7, 35.8), and lowest in AHF (5.4, 2.7, 33.6). The in-group HD standard deviations and ranges measurements were large, indicating heterogeneous underlying HD profiles. Presenting SVI predicted 30-day mortality for all groups.
  
  
  CONCLUSIONS
  Presenting ED noninvasive HD data has not been previously reported in any large patient population. Our data suggest a potential role for early noninvasive HD assessments aiding in diagnosing of patients, individualizing therapy based on each person's unique HD values and predicting 30-day mortality. Further studies and analyses are needed to determine how HD assessments should be best used in the ED.
authors.affiliation: Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.affiliation: VU University Medical Center, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Prabath
authors.initials: P
authors.lastname: Nanayakkara
authors.affiliation: Sant' Andrea Hospital, Department of Emergency Medicine, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: DiSomma
authors.affiliation: Wayne State University, Department of Emergency Medicine and Cardiovascular Research Institute, Detroit, Michigan.
authors.forename: Phillip
authors.initials: P
authors.lastname: Levy
authors.affiliation: VU University Medical Center, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Edmée
authors.initials: E
authors.lastname: Schrijver
authors.affiliation: Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Huyghe
authors.affiliation: Sant' Andrea Hospital, Department of Emergency Medicine, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Autunno
authors.affiliation: Wayne State University, Department of Emergency Medicine and Cardiovascular Research Institute, Detroit, Michigan.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sherwin
authors.affiliation: Henry Ford Health System, Department of Biostatistics, Detroit, Michigan.
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.affiliation: Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Michele
authors.initials: M
authors.lastname: Moyer
mesh_terms: D001794:Blood Pressure; D002302:Cardiac Output; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D018805:Sepsis / Q000503:physiopathology*; D020521:Stroke / Q000503:physiopathology*; D014655:Vascular Resistance