Short-term Mortality Risk in Emergency Department Acute Heart Failure

Authors

  • W. Frank Peacock MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Richard Nowak MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Robert Christenson PhD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Salvatore DiSomma MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Sean Xavier Neath MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Oliver Hartmann,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Christian Mueller MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Piotr Ponikowski MD, PhD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Martin Möckel MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Christopher Hogan MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Alan H. B. Wu PhD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Mark Richards MD, PhD, FRACP,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Gerasimos S. Filippatos MD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Inder Anand MD, FRCP, D Phil (Oxon.),

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Leong L. Ng MD, FRCP,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Lori B. Daniels MD, MAS,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Nils Morgenthaler MD, PhD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Stefan D. Anker MD, PhD,

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Alan S. Maisel MD

    1. From the Department of Emergency Medicine, Cleveland Clinic Foundation (WFP), Cleveland, OH; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Department of Pathology, University of Maryland School of Medicine (RC), Baltimore, MD; the Emergency Medicine Department, Sant’Andrea Hospital, University La Sapienza (SD), Rome, Italy; the Department of Emergency Medicine (SXN), Division of Cardiology (LBD), University of California, San Diego, CA; BRAHMS Aktiengesellschaft, Biotechnology Centre Hennigsdorf/Berlin (OH, NM), Berlin, Germany; the Department of Internal Medicine, University Hospital Basel (CM), Basel, Switzerland; Medical University, Department of Heart Diseases, Military Hospital (PP), Wroclaw, Poland; the Department of Cardiology, Charité Universitätsmedizin (MM), Berlin, Germany; the Department of Emergency Medicine, Virginia Commonwealth University Medical Center (CH), Richmond, VA; the Departments of Pathology and Laboratory Medicine, University of California (AHBW), San Francisco, CA; the Department of Medicine, University of Otago (MR), Christchurch, New Zealand; the Department of Cardiology, University of Athens (GSF), Athens, Greece; the Department of Cardiology, University of Minnesota Medical School, VA Medical Center (IA), Minneapolis, MN; Cardiovascular Sciences, Leicester Royal Infirmary, University of Leicester (LLN), Leicester, UK; Charité Universitätsmedizin Berlin, Department of Cardiology and the Centre for Clinical and Basic Research, San Raffaele (SDA), Rome, Italy; and the VA San Diego Healthcare System (ASM), San Diego, CA.
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  • Conflict of interest disclosures: W. Frank Peacock—scientific advisory board at Abbott, Beckman-Coulter, Biosite, Inverness, and Response Biomedical; research grants from Abbott, BRAHMS, Biosite, and Inverness. Richard M. Nowak—research grants from BRAHMS. Robert Christenson—scientific advisory board at Siemens, Biosite, Inverness, Ortho Clinical Diagnostics, and Response Biomedical; research grants from Biosite, Inverness, Siemens, Roche, and BRAHMS. Salvatore DiSomma—consultant for Biosite; research grants from BRAHMS. Sean Xavier Neath—no conflicts of interest. Oliver Hartmann—statistical consultant and employee of BRAHMS GmbH (manufacturer of the MR-proANP, copeptin, and MR-proADM assays). Christian Mueller—scientific advisory board at Abbott and BRAHMS; research grants from Abbott, BRAHMS, Biosite, and Nanosphere. Piotr Ponikowski—no conflict of interest. Martin Mockel—research grants from BRAHMS. Christopher Hogan—no conflicts of interest. Alan H.B. Wu—research grants from BRAHMS and Response Biomedical; scientific advisory board at Beckman, Abbott, and Inverness. Mark Richards—honoraria and consultancy for Inverness, BRAHMs, and Roche Diagnostics. Gerasimos S. Filippatos—research grant from BRAHMS. Inder Anand—research grant from BRAHMS. Leong L. Ng—research grants from BRAHMS. Lori B. Daniels—research grants from Biosite and Roche. Nils Morgenthaler—employee of BRAHMS GmbH (manufacturer of the MR-proANP, Copeptin and MR-proADM assays). Stefan D. Anker—research grants from BRAHMS; honoraria from Abbott and Biosite; consultant for BRAHMS, Inverness, and Abbott. Alan S. Maisel—research grants from Roche, Biosite, and Bayer; consultant for Biosite.

  • Bach Trial Registration. ClinicalTrials.gov Identifier: NCT00537628.

  • Supervising Editor: Stephen Smith, MD.

Address for correspondence and reprints: W. Frank Peacock, MD; e-mail: Peacocw@ccf.org.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:947–958 © 2011 by the Society for Academic Emergency Medicine

Abstract

Objectives:  Few tools exist that provide objective accurate prediction of short-term mortality risk in patients presenting with acute heart failure (AHF). The purpose was to describe the accuracy of several biomarkers for predicting short-term death rates in patients diagnosed with AHF in the emergency department (ED).

Methods:  The Biomarkers in ACute Heart failure (BACH) trial was a prospective, 15-center, international study of patients presenting to the ED with nontraumatic dyspnea. Clinicians were blinded to all investigational markers, except troponin and natriuretic peptides, which used the local hospital reference range. For this secondary analysis, a core lab was used for all markers except troponin. This study evaluated patients diagnosed with AHF by the on-site emergency physician (EP).

Results:  In the 1,641 BACH patients, 466 (28.4%) had an ED diagnosis of AHF, of whom 411 (88.2%) had a final diagnosis of AHF. In the ED-diagnosed HF patients, 59% were male, 69% had a HF history, and 19 (4.1%) died within 14 days of their ED visit. The area under the curve (AUC) for the 14-day mortality receiver operating characteristic (ROC) curve was 0.484 for brain natriuretic peptide (BNP), 0.586 for N-terminal pro-B-type natriuretic peptide (NT-proBNP), 0.755 for troponin (I or T), 0.742 for adrenomedullin (MR-proADM), and 0.803 for copeptin. In combination, MR-proADM and copeptin had the best 14-day mortality prediction (AUC = 0.818), versus all other markers.

Conclusions:  MR-proADM and copeptin, alone or in combination, may provide superior short-term mortality prediction compared to natriuretic peptides and troponin. Presented results are explorative due to the limited number of events, but validation in larger trials seems promising.

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