International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes

Sean P. Collins, Peter Pang, Christopher J. Lindsell, Demetrios N. Kyriacou, Alan B. Storrow, Judd E. Hollander, J. Douglas Kirk, Chadwick D. Miller, Richard Nowak, W. Frank Peacock, Miguel Tavares, Alexandre Mebazaa, Mihai Gheorghiade

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

AimsResults from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe. Methods and resultsThe URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ2 tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40 when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8) and Western Europe (24.4) compared with the USA (2.5). ConclusionInternational differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.

Original languageEnglish (US)
Pages (from-to)1253-1260
Number of pages8
JournalEuropean Journal of Heart Failure
Volume12
Issue number11
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Eastern Europe
Hospital Emergency Service
Heart Failure
Dyspnea
Therapeutics
Natriuretic Peptides
Nitroglycerin
Pulmonary Edema
Diuretics
Observational Studies
Analysis of Variance
Electrocardiography
Thorax
Clinical Trials
Prospective Studies
Physicians

Keywords

  • Emergency
  • Geographical differences
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes. / Collins, Sean P.; Pang, Peter; Lindsell, Christopher J.; Kyriacou, Demetrios N.; Storrow, Alan B.; Hollander, Judd E.; Douglas Kirk, J.; Miller, Chadwick D.; Nowak, Richard; Frank Peacock, W.; Tavares, Miguel; Mebazaa, Alexandre; Gheorghiade, Mihai.

In: European Journal of Heart Failure, Vol. 12, No. 11, 11.2010, p. 1253-1260.

Research output: Contribution to journalArticle

Collins, SP, Pang, P, Lindsell, CJ, Kyriacou, DN, Storrow, AB, Hollander, JE, Douglas Kirk, J, Miller, CD, Nowak, R, Frank Peacock, W, Tavares, M, Mebazaa, A & Gheorghiade, M 2010, 'International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes', European Journal of Heart Failure, vol. 12, no. 11, pp. 1253-1260. https://doi.org/10.1093/eurjhf/hfq133
Collins, Sean P. ; Pang, Peter ; Lindsell, Christopher J. ; Kyriacou, Demetrios N. ; Storrow, Alan B. ; Hollander, Judd E. ; Douglas Kirk, J. ; Miller, Chadwick D. ; Nowak, Richard ; Frank Peacock, W. ; Tavares, Miguel ; Mebazaa, Alexandre ; Gheorghiade, Mihai. / International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes. In: European Journal of Heart Failure. 2010 ; Vol. 12, No. 11. pp. 1253-1260.
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abstract = "AimsResults from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe. Methods and resultsThe URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ2 tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40 when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8) and Western Europe (24.4) compared with the USA (2.5). ConclusionInternational differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.",
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T1 - International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes

AU - Collins, Sean P.

AU - Pang, Peter

AU - Lindsell, Christopher J.

AU - Kyriacou, Demetrios N.

AU - Storrow, Alan B.

AU - Hollander, Judd E.

AU - Douglas Kirk, J.

AU - Miller, Chadwick D.

AU - Nowak, Richard

AU - Frank Peacock, W.

AU - Tavares, Miguel

AU - Mebazaa, Alexandre

AU - Gheorghiade, Mihai

PY - 2010/11

Y1 - 2010/11

N2 - AimsResults from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe. Methods and resultsThe URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ2 tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40 when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8) and Western Europe (24.4) compared with the USA (2.5). ConclusionInternational differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.

AB - AimsResults from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe. Methods and resultsThe URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ2 tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40 when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8) and Western Europe (24.4) compared with the USA (2.5). ConclusionInternational differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.

KW - Emergency

KW - Geographical differences

KW - Heart failure

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DO - 10.1093/eurjhf/hfq133

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JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

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