0448: Treatment of acute cardiac failure in the emergency department. Improve our practices? Data from the RESURCOR network

Abstract

Admission of patients with acute cardiac failure (ACF) is common in emergency departments (EDs), but taking care of them is challenging. Based on a retrospective evaluation of clinical practices in a network of 16 hospitals in the French Alps, we developed a programme of improvements. We report preliminary data from the first evaluation of this programme. We undertook a retrospective evaluation of clinical practices in ACF patients admitted to the ED in 2013 (phase 1). In 2015, following a review of these practices, we implement a set of recommendations, which were evaluated in 2016 (phase 2). The study population comprised patients admitted to the ED with an admission diagnosis of ACF. Data, including patient characteristics and practices, were collected retrospectively from the medical records. We report preliminary data from 155 patients included in phase 1 of this evaluation. Patients’ mean±SD age was 84.3±7.9 years and 63 (41%) were men. Among 38 patients with oxygen saturation <90% or breath rate >30/min despite nasal oxygen, 9 (24%) underwent non-invasive ventilation. Thirty-three (25%) of 133 patients with systolic arterial pressure >110mmHg were treated with nitroglycerine. One patient was treated with morphine. Sixteen patients (10%) underwent echocardiography in the ED. By September 2015, phase 1 data from 1000 patients will be collected from the 16 hospitals, analysed and will be presented at the meeting. These initial data show that nitroglycerine, morphine, noninvasive ventilation, and echocardiography seem not commonly used at the first point of medical care for patients presenting with ACF.