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QUARTERLY FOCUS ISSUE: HEART FAILURE: STATE-OF-THE-ART PAPER

National Heart, Lung, and Blood Institute Working Group on Emergency Department Management of Acute Heart Failure

Research Challenges and Opportunities

W. Frank Peacock, MD^_*,_*, Eugene Braunwald, MD, William Abraham, MD, Nancy Albert, PhD, MSN^_*, John Burnett, MD, Rob Christenson, PhD^||, Sean Collins, MD, MSc^¶, Deborah Diercks, MD, MSc^#, Greg Fonarow, MD^_**, Judd Hollander, MD, Art Kellerman, MD, MPH, Mihai Gheorghiade, MD, Doug Kirk, MD^#, Phil Levy, MD, MPH^||||, Alan Maisel, MD^¶¶, Barry M. Massie, MD^##,_***, Christopher O'Connor, MD, Peter Pang, MD, Monica Shah, MD, MHS, MSJ, George Sopko, MD, MPH, Lynne Stevenson, MD, Alan Storrow, MD^|||||| and John Teerlink, MD^_***

^_* The Cleveland Clinic, Cleveland, Ohio
Harvard Medical School, Brigham and Women‘s Hospital, Boston, Massachusetts
Ohio State University, Columbus, Ohio
Mayo Foundation, Rochester, Minnesota
^|| University of Maryland School of Medicine, Baltimore, Maryland
^¶ University of Cincinnati, Cincinnati, Ohio
^# University of California, Davis Medical Center, Sacramento, California
^_** Geffen School of Medicine at UCLA, Los Angeles, California
University of Pennsylvania, Philadelphia, Pennsylvania
Emory School of Medicine, Atlanta, Georgia
Northwestern University Feinberg School of Medicine, Chicago, Illinois
^|||| Wayne State University School of Medicine, Detroit, Michigan
^¶¶ University of California at San Diego, San Diego, California
^## University of California at San Francisco, San Francisco, California
^_*** San Francisco Veterans Affairs Medical Center, San Francisco, California
Duke University, Durham, North Carolina
National Heart, Lung, and Blood Institute, Bethesda, Maryland
Harvard Medical School, Boston, Massachusetts
^|||||| Vanderbilt University, Nashville, Tennessee

Manuscript received January 17, 2010; revised manuscript received March 2, 2010, accepted March 5, 2010.

^_* Reprint requests and correspondence: Dr. W. Frank Peacock, Desk E-19, Emergency Medicine Institute, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195 (Email: Peacocw{at}ccf.org).

This paper details the substance and recommendations arising from a meeting convened by the National Heart, Lung, and Blood Institute in August 2009, to assess the challenges and opportunities of emergency department management of acute heart failure syndrome (AHFS). The assembled faculty represented a large cross section of medical professionals spanning the medical management continuum of patients presenting with acute heart failure and included heart failure cardiologists, emergency physicians, laboratory medicine specialists, nurses, and bench scientists. Their recommendations include proposals regarding the design and conduct of emergency department-based clinical trials, suggestions regarding the development of improved methods for early detection and monitoring of AHFS, and potential needs for expanding translational and applied AHFS focused research and biotechnology. We anticipate that this review will serve as a starting point for future investigations across the spectrum of funding sources.

Key Words: emergency medicine • heart failure • research

Abbreviations and Acronyms   AHFS = acute heart failure syndrome   ED = emergency department   HF = heart failure   NP = natriuretic peptide   OU = observation unit

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