Emergency-department training course on improving the management of acute heart failure: evaluation of effectiveness

Escoda R, Llorens Soriano P, Martín-Sánchez FJ, Jacob J, Pavón J, Gil C, Herrero Puente P, Perelló R, Bella AM, Fuentes Ferrer M, Gil V

Background and objective: Current guidelines on the diagnostic and therapeutic

management of acute heart failure have not been strictly followed in hospital emergency

departments. This study aimed to assess whether a training course for emergency

physicians improved compliance with recommended practices.

Methods: A quasi-experimental study, without a control group, was designed to

compare compliance pre- and post-training. In the first phase, we included data for 708

consecutive patients who received a principal diagnosis of acute heart failure at 6

Spanish hospitals within 1 month. In the second phase, we organized guidelines-based

training on the management of acute heart failure. After the intervention, we included

data for 613 consecutive patients following the same methodology. The main outcome

variables were the ones that previous studies had identified as deviating most from

current guidelines (determination of serum levels of troponin, brain natriuretic peptide

[BNP], and N-terminal prohormone-BNP [NT-pro-BNP]; use of furosemide in continuous

perfusion or intravenous nitroglycerin; and use of noninvasive ventilation).

Results: Few statistically significant differences in patient, clinical, or outpatient

treatment characteristics were detected between the pre- and post-training patient

groups, although there was a slightly greater percentage of cerebrovascular disease,

chronic respiratory disease, systolic dysfunction, and outpatient treatment with β-

blockers in the post-intervention group. BNP or NT-pro-BNP determinations were

performed significantly more often after training (absolute increased in score, 44.7%;

95% confidence interval [CI], 39.9-49.5; P<.001); the use of intravenous nitroglycerin also increased (odds ratio, 6.9; 95% CI, 2.2-11.5; P<.01). We observed a nonsignificant trend toward more frequent determination of troponin level and use of furosemide and noninvasive ventilation. Conclusions: A training program on the diagnostic and therapeutic management of acute heart failure improves hospital emergency service compliance with current guidelines.

Bella AM, Escoda R, Fuentes Ferrer M, Gil C, Gil V, Herrero Puente P, Jacob J, Llorens Soriano P, Martín-Sánchez FJ, Pavón J, Perelló R