Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis

Area of Science:

• Emergency Medicine
• Cardiology
• Diagnostic Accuracy

Background:

• Acute heart failure (AHF) is a common, yet challenging, diagnosis in emergency departments.
• Differentiating AHF from other causes of undifferentiated dyspnea requires accurate diagnostic tools.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic performance of tests for AHF in emergency settings.
• To develop a test-treatment threshold model and calculate likelihood ratios (LRs) for natriuretic peptides (NPs).

Main Methods:

• Systematic review and meta-analysis of studies published from 1965 to 2015.
• Evaluated index tests including history, physical exam, ECG, CXR, BNP, NT-proBNP, lung ultrasound (US), and echocardiography.
• Utilized Meta-DiSc software and QUADAS-2 for data analysis and quality assessment.

Main Results:

• Pulmonary edema on CXR (LR=4.8) and lung US (LR=7.4), and reduced ejection fraction on echocardiogram (LR=4.1) were strong indicators of AHF.
• BNP < 100 pg/mL (LR=0.11) and NT-proBNP < 300 pg/mL (LR=0.09) effectively excluded AHF.
• Lung US with B-lines (LR=0.16) also helped rule out AHF.

Conclusions:

• Bedside lung ultrasound and echocardiography are highly valuable for confirming AHF diagnoses.
• Natriuretic peptides (BNP and NT-proBNP) are most useful for excluding AHF in emergency patients.