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Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial.

Publication ,  Journal Article
Drazner, MH; Hellkamp, AS; Leier, CV; Shah, MR; Miller, LW; Russell, SD; Young, JB; Califf, RM; Nohria, A
Published in: Circ Heart Fail
September 2008

BACKGROUND: We determined whether estimated hemodynamics from history and physical examination (H&P) reflect invasive measurements and predict outcomes in advanced heart failure (HF). The role of the H&P in medical decision making has declined in favor of diagnostic tests, perhaps due to lack of evidence for utility. METHODS AND RESULTS: We compared H&P estimates of filling pressures and cardiac index with invasive measurements in 194 patients in the ESCAPE trial. H&P estimates were compared with 6-month outcomes in 388 patients enrolled in ESCAPE. Measured right atrial pressure (RAP) was <8 mm Hg in 82% of patients with RAP estimated from jugular veins as <8 mm Hg, and was >12 mm Hg in 70% of patients when estimated as >12 mm Hg. From the H&P, only estimated RAP > or =12 mm Hg (odds ratio [OR] 4.6; P<0.001) and orthopnea > or =2 pillows (OR 3.6; P<0.05) were associated with pulmonary capillary wedge pressure (PCWP) > or =30 mm Hg. Estimated cardiac index did not reliably reflect measured cardiac index (P=0.09), but "cold" versus "warm" profile was associated with lower median measured cardiac index (1.75 vs. 2.0 L/min/m(2); P=0.004). In Cox regression analysis, discharge "cold" or "wet" profile conveyed a 50% increased risk of death or rehospitalization. CONCLUSIONS: In advanced HF, the presence of orthopnea and elevated jugular venous pressure are useful to detect elevated PCWP, and a global assessment of inadequate perfusion ("cold" profile) is useful to detect reduced cardiac index. Hemodynamic profiles estimated from the discharge H&P identify patients at increased risk of early events.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

September 2008

Volume

1

Issue

3

Start / End Page

170 / 177

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • ROC Curve
  • Pulmonary Wedge Pressure
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • Heart Failure
 

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Drazner, M. H., Hellkamp, A. S., Leier, C. V., Shah, M. R., Miller, L. W., Russell, S. D., … Nohria, A. (2008). Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial. Circ Heart Fail, 1(3), 170–177. https://doi.org/10.1161/CIRCHEARTFAILURE.108.769778
Drazner, Mark H., Anne S. Hellkamp, Carl V. Leier, Monica R. Shah, Leslie W. Miller, Stuart D. Russell, James B. Young, Robert M. Califf, and Anju Nohria. “Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial.Circ Heart Fail 1, no. 3 (September 2008): 170–77. https://doi.org/10.1161/CIRCHEARTFAILURE.108.769778.
Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD, et al. Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial. Circ Heart Fail. 2008 Sep;1(3):170–7.
Drazner, Mark H., et al. “Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial.Circ Heart Fail, vol. 1, no. 3, Sept. 2008, pp. 170–77. Pubmed, doi:10.1161/CIRCHEARTFAILURE.108.769778.
Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD, Young JB, Califf RM, Nohria A. Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial. Circ Heart Fail. 2008 Sep;1(3):170–177.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

September 2008

Volume

1

Issue

3

Start / End Page

170 / 177

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • ROC Curve
  • Pulmonary Wedge Pressure
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • Heart Failure