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(553) Noninvasive Hemodynamics of Acute Heart Failure in the Emergency Department Utilizing the ClearSightâ„¢ System


Authors:

Sarah Meram, MS – Research Assistant, Wayne State University School of Medicine Department of EM Research

Xiangrui Li, MS

Christine Lee, PhD

Dongxiao Zhu, PhD

Peter Pang, MD, MS – Professor, Indiana University

Patrick Medado, n/a

Phillip Levy, MD, MPH – Assc Chair for Research, Department of Emergency Medicine and Asst VP for Translational Science and, Wayne State University

Sarah Meram, MS – Research Assistant, Wayne State University School of Medicine Department of EM Research

Abstract:

Background and Objectives: In depth characterization of the hemodynamic (HD) profiles of African American patients who present to the ED with acute heart failure (AHF) is not well known. We sought to identify HD characteristics of AHF patients with a goal of identifying therapeutic targets to improve clinical outcomes.

Methods: We used an on-going prospective, observational registry to identify patients who presented with signs and symptoms of AHF at two large, urban academic EDs: Wayne State University (Detroit, MI) and Indiana University (Indianapolis, IN). 350 patients were enrolled from July 2017 to March 2019. Continuous ED HD data was collected using the non-invasive ClearSightâ„¢ System. Mean values for HD variables were taken at four timepoints. Those with an ED diagnosis of AHF as adjudicated by site PIs and available ejection fraction (EF) were included. Clinical outcomes of 30-day readmission and mortality were recorded. Consensus clustering with K-means as the base algorithm was performed to help identify the groups with similar HD characteristics using 20 HD and demographic features. Cluster group comparisons were analyzed using a two-sample t-test.

Results: There were 164 adjudicated cases of AHF with prior EF and known clinical outcomes included. The population was predominately African American (92.5%) males (63.8%) with an average age of 58.9. There was no clear clustering effect found. However, within a mainly reduced EF (defined as < 40%) population (73.8%), two subgroups were identified. While both clusters had similar heart rates (cluster 1 85.2 bpm SD 13.3; cluster 2 87.9 bpm SD 12.6; p-value 0.36) statistically distinct HD characteristics were found. Cluster 1 (n=48) had normal SBP (99.2 SD 18.9/66.4 SD 13.1), decreased dPdT (379.1 SD 154.3), and a lower cardiac output [CO] (4.1 SD 1.5). Cluster 2 (n=32) had markedly higher SBP (167.1 SD 20.6/97.9 SD 11.5), increased dPdT (827.9 SD 288.2) and significantly elevated CO (5.8 SD 1.3). All p-values for SBP, dPdT and CO were <0.00001. Cluster 1 had a higher rate of 30-day readmissions (16.7%) than cluster 2 (9.4%).

Conclusion: Two diverse clusters were identified using non-invasive HD monitoring in the ED for AHF patients. More research is needed to demonstrate the effects of treatments specifically tailored to these HD characteristics that will lead to improved clinical outcomes for patients with AHF in the ED setting.

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