Treatment of acute cardiac failure in the emergency department. Improve our practices? Data from the RESURCOR network.

Background In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: – use of intravenous vasodilators (nitrates) when systolic blood pressure is > 110 mmHg; – non-invasive ventilation if oxygen saturation is   25/min despite nasal oxygen; – using a reduced dose of intravenous furosemide (20–40 mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; – early performance of echocardiography. We sought to compare the gap between these recommendations and clinical practices in French emergency departments (EDs). Methods We undertook a retrospective evaluation of clinical practices in 834 consecutive patients with ACF admitted in 2013 to the EDs of 16 French hospitals. Data, including patient characteristics and practices were collected from the medical records. Results Patients’ mean ± standard deviation age was 82 ± 10 years and 49% were men. Clinical practices in relation to the guideline recommendations are shown in the Table 1 . Conclusions These initial data which precede publication of the current guidelines, show that use of nitrates, non-invasive ventilation, reduced diuretic dose and early echocardiography were relatively infrequent at the first point of medical care for patients presenting with ACF. These findings indicate the need for a sizable shift in practice in order to meet the new guideline recommendations. We will conduct a repeat evaluation in 2016, after implementation of a programme aimed to improve practices at these sites.