Tool will help sort ER heart patients

Tag : Tool & Die
One heart-failure patient isn't necessarily like the next, andbetter evaluations in emergency departments might save lives,according to a study in this week's Journal of the American College of Cardiology .
The new information, which includes a tool to help doctorsdetermine the risk of death during hospitalization, comes from abroad study exploring the care of 48,612 heart-failure patientsadmitted to 259 U.S. hospitals.
There are risk factors that doctors and nurses can't do anythingabout, such as age. But others, such as high blood pressure andimpaired kidney function, can be better observed and treated.
Heart failure is a chronic, progressive condition in which theheart's muscle becomes weakened after it is injured by a heartattack or high blood pressure and gradually loses its ability topump enough blood.
Heart failure can lead to swelling, shortness of breath andenlargement of the heart, among other things, and it is the leadingcause of hospital admission among people 65 or older.
American Heart Association statistics show that 5.3 million peopleare living with the disease and 550,000 cases are diagnosed eachyear. About 250,000 people die of the disease each year, the HeartFailure Society of America says.
Sorting out patients who belong in an intensive-care unit and neednew or different medicines from those who just need monitoring hasbeen a murky area, said Dr. William Abraham, director ofcardiovascular medicine at the Ohio State University Medical Centerand lead author of the paper.
The new research comes with an online tool that takes severalfactors into account and suggests the odds that a patient will diein the hospital.
Determining risk can help doctors sort patients and adjusttreatments, Abraham said.
What remains unclear is how much of a difference the scoring systemcan make.
"The next line of work that we need to do is target those thingsand prove that the outcomes are better," he said.
A tremendous amount of resources goes into caring for heart-failurepatients, and much work is under way to try to improve care andoutcomes, said Dr. Randall Starling, head of Heart Failure andCardiac Transplant Medicine at the Cleveland Clinic.
In some cases, it's obvious that a patient belongs in intensivecare, but the best approach for other patients might be unclear,said Starling, who did not work on this research. It is common forpatients to be admitted to the hospital for a couple days and thenmoved to intensive care once their condition worsens, he said.
Getting people on the right medicines -- and the right amount ofthose medicines -- can make a big difference, said Nancy Albert,who worked on the study and is director of nursing research and aclinical nurse specialist at the Cleveland Clinic's Kaufman Centerfor Heart Failure.
Heart failure is ideally cared for in doctors' offices but, asevidenced by the number of people showing up in emergencydepartments, the disease isn't always well-managed, she said.
Other groups have made similar efforts to determine risk, but thenew scoring system includes new measures and is the most complete,Albert said.
mcrane@dispatch.com