Heart Failure, Tachypnea
Conditions
Keywords
biomarker, tachypnea, heart failure, echocardiography
Brief summary
Patients hospitalized with tachypnea, defined as respiratory rate ≥20/ min, have substantial mortality and may suffer from different conditions, including acute heart failure (HF). Symptoms of HF can be difficult to identify and \ 15% of patients with HF will not be correctly diagnosed by the treating physician in the Emergency Department. Biomarkers like B-type natriuretic peptides and cardiac troponins improve diagnostic accuracy and risk stratification. Whether early, structured biomarker assessment and structured feedback in the patient's electronic health records improve management and outcomes among unselected patients with tachypnea have previously not been explored in a randomized controlled trial. The main research question of the study is to determine whether early structured biomarker assessment in unselected patients with tachypnea extends the time to the first event for either (1) all-cause readmission or (2) all-cause mortality; i.e. time to the combined endpoint, compared to the current strategy/standard care
Interventions
OTHEREarly biomarker-based cardiological assessment
We will perform cardiac biomarker testing with NT-proBNP and hs-cTnT measurements on emergency department admission in all participants, regardless of randomization status. The results will be provided in the patient's EHR, regardless of randomization status. For patients randomized to the intervention group, we will provide a note in the patient's EHR that includes assessment of probability that myocardial injury or dysfunction are the underlying pathophysiology responsible for tachypnea, as evaluated by the cardiac biomarker algorithm of the study. We will inform on general recommendations for work up and treatment.
Sponsors
University Hospital, Akershus
University of Oslo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients ≥18 years old * Tachypnea (respiratory rate ≥20/min) * Admission to Departments under the Division of Medicine at Akershus University Hospital, except the Department of Neurology * \<24 h from hospital admittance to inclusion in the study * Signed written informed consent during the initial phase of the hospitalization
Exclusion criteria
* Previously included into the study (in case of patients presenting with a second hospitalization during the study period) * Known or suspected cancer outside of local control, documented in medical records, at the time of patient inclusion or diagnosed in relation to the index hospitalization * Neurological condition with short life expectancy; e.g. ALS, documented in medical records during screening prior to study entry * Other non-cardiac disease with life expectancy below 1 year, documented in medical records during screening prior to study entry * Obvious non-cardiac cause for tachypnea based on medical records and clinical findings during screening prior to study entry; e.g. anaphylaxis in young patient with known allergy, dyspnea after direct chest trauma, or young patient with fever and positive Covid-19 test on admission. * Patient assessed as non-Internal Medicine patient; e.g. surgical patient * Patients unwilling or unable to comply with the protocol, including Glasgow Coma Scale \<13 on the time of study inclusion * Patients that are intubated for invasive ventilatory therapy before or shortly after hospital admission * History of non-compliance to medical management and patients who are considered potentially unreliable, based on documentation in medical records, during screening prior to study entry * History or evidence of alcohol or drug abuse with the last 12 months, based on medical records and clinical findings during screening prior to study entry, that will influence study participation * Any surgical or medical condition, based on medical records and clinical findings during screening prior to study entry, that will impair the ability of the patient to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite of all-cause hospital readmission or all-cause mortality | 12 months after discharge from index hospitalization | Composite of all-cause hospital readmission or all-cause mortality after discharge from index hospitalization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital length of stay | From admission to discharge of index hospitalization, assessed up to 12 months | Hospital length of stay during the index hospitalization |
| Length of stay in Intensive Care Unit/Medical Intensive Care Unit/Cardiac Intensive Care Unit | From admission to discharge of index hospitalization, assessed up to 12 months | Length of stay in Intensive Care Unit/Medical Intensive Care Unit/Cardiac Intensive Care Unit during the index hospitalization |
| 30-day all-cause readmission | 30-days after discharge from index hospitalization | 30-day all-cause readmission after discharge from index hospitalization |
| Time to all-cause readmission | 12 months after discharge from index hospitalization | Time to first all-cause readmission after discharge from index hospitalization |
| Number of all-cause readmission | 12 months after discharge from index hospitalization | Number of all-cause readmissions after discharge from index hospitalization |
| All-cause mortality | 12 months after discharge from index hospitalization | Time to all-cause mortality after discharge from index hospitalization |
| Total cost of hospitalization | From admission to discharge of index hospitalization, assessed up to 12 months | Total cost of hospitalization |
| Difference in cardiac biomarker concentrations during index hospitalization | From admission to discharge of index hospitalization, assessed up to 12 months | Difference in the cardiac troponin T and/or I and B-type natriuretic peptide and/or N-terminal pro-B-type natriuretic peptide concentrations from hospital admission to discharge |
| Difference in guideline-defined medical therapy for heart failure | From admission to discharge of index hospitalization, assessed up to 12 months | Difference in guideline-defined medical therapy for heart failure, as defined by international guidelines, at discharge after index hospitalization |
| Cost-utility | From admission to discharge of index hospitalization, assessed up to 12 months | Cost-utility for the intervention strategy |
Countries
Norway
Contacts
PRINCIPAL_INVESTIGATORMagnus N Lyngbakken, MD PhD
University Hospital, Akershus
Outcome results
None listed