Nitrates for Acute Pulmonary Edema, Diuretic Prescriptions for CHF Prevention, POCUS for CHF Diagnosis

This month JC will be looking at another “bread and butter” ED complaint namely, ED management of the patient with acute decompensated heart failure. Our own Dr. Bruce Lo as a member of the ACEP Clinical Policies Subcommittee on Acute Heart Failure Syndromes assisted in the development of the 2022 Clinical Policy on heart failure that addressed four fundamental questions and the available evidence in support of their recommendations. In addition, in 2022, the AHA/ACC/HFSA published a Guideline for the Management of Heart Failure that is fairly comprehensive in its scope but not very specific to ED management however, warrants your review. Our focus for JC will include a few EBM topics such as what entails systematic review and guideline development. We will also address a few more pragmatic clinical questions such as the use of POCUS, high-dose nitrates and diuretics in the diagnosis and management of the acute heart failure patient.  

Kelly GS, et al., Low- versus high-dose nitroglycerin infusion in the management of acute pulmonary edema. Am J Emerg Med. 2023 Mar;65:71-75. Appraisal

Faselis C, et al., Loop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure. J Am Coll Cardiol. 2020 Aug 11;76(6):669-679. Appraisal

McGivery K et al., Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis. CJEM. 2018 May;20(3):343-352. Appraisal