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Ottawa Heart Failure Risk Score

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1. Ottawa Heart Failure Risk Score

Ottawa Heart Failure Risk Score Ottawa Heart Failure Risk Score Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ottawa Heart Failure (...) Risk Score Ottawa Heart Failure Risk Score Aka: Ottawa Heart Failure Risk Score , Ottawa Heart Failure Risk Scale From Related Chapters II. Criteria History Score 1: Stroke or (TIA) Score 2: Intubation for respiratory distress Exam Score 2: on ED arrival >110 bpm Score 1: <90% on arrival Score 1: >110 during 3 minute walk test (or unable to perform) Investigation Score 2: (EKG) with acute ischemic changes Score 1: (BUN) >33.6 mg/dl (12 mmol/L) Score 2: Serum CO2 (or serum bicarbonate) >35 mg/dl

2018 FP Notebook

2. The Ottawa heart failure risk scale

for the Ottawa heart failure scale. I will wait until I see that (which, unfortunately, will take a long time) before I start using this scale. Right now, this scale gives us a sense of the risk to our patients, but it isn’t clear that we know how to prevent the adverse events reported. Does a hospital admission really help these patients? Might it hurt? All we know is, as is demonstrated by their data, this score is very likely to result in more patients being admitted to hospital. I want to see an RCT (...) The Ottawa heart failure risk scale The Ottawa heart failure risk scale - First10EM Search The Ottawa heart failure risk scale by | Published - Updated | A new episode of the SGEM hot off the press just went up. Ken and I spoke to Ian Stiell about his Ottawa heart failure risk scale. Reference: You can listen to the podcast and leave you comments on the SGEM: Dr. Stiell thinks this decision tool is ready to be used right now. This is THE Dr. Stiell. You know: Ottawa ankle rule, Canadian CT head

2017 First10EM

3. Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. (PubMed)

Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. We previously developed the Ottawa Heart Failure Risk Scale (OHFRS) to assist with disposition decisions for acute heart failure patients in the emergency department (ED). We sought to prospectively evaluate the accuracy, acceptability, and potential impact of OHFRS.This prospective observational cohort study was conducted at six tertiary hospital EDs. Patients (...) sensitive for SAEs in acute heart failure patients, albeit with an increase in admission rates. When available, NT-proBNP values further improve sensitivity. With adequate physician training, OHFRS should help improve and standardize admission practices, diminishing both unnecessary admissions for low-risk patients and unsafe discharge decisions for high-risk patients.© 2016 by the Society for Academic Emergency Medicine.

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2016 Academic Emergency Medicine

4. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

prognostic value at previously undetectable concentrations. In the Val-HeFT trial (Valsartan Heart Failure Trial) of 4053 stable patients with chronic HF without overt evidence of myocardial ischemia or infarction, detectable TnT levels were associated with an increased risk of death (HR, 2.08; 95% CI, 1.72–2.52) and first hospitalization for HF (HR, 1.55; 95% CI, 1.25–1.93) at 2 years. Soluble ST2 Compared with other biomarkers such as natriuretic peptides, advantages of sST2 include that its (...) -proADM (midregional proadrenomedullin) was associated with mortality at 3 months with a prognostic value beyond natriuretic peptides. In the Australia-New Zealand Heart Failure Study, above-median levels of MR-proADM predicted increased risk of mortality (risk ratio, 3.92; 95% CI, 1.76–8.7) and of HF hospitalization (risk ratio, 2.4; 95% CI, 1.3–4.5) independently of traditional clinical and echocardiographic factors. Treatment with carvedilol reduced the risk of death or HF hospitalization

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2017 American Heart Association

5. Suspected New-Onset and Nonacute Heart Failure

changes in static images (ie, CTA; or, without the use ACR Appropriateness Criteria ® 6 Suspected New-Onset and Known Nonacute Heart Failure of intravenous contrast for coronary calcification, calcium scoring for risk stratification). Delayed imaging helps further the detection of fibrous or fatty tissue replacement in cardiac structures (eg, LV wall) [26,29,30]. Despite marked improvements, prevailing concerns about potential complications are still limitations to the use of this modality (...) ). Although LVEF has not been found to be a consistent risk marker [51], the distinction between reduced ( =40%) and relatively preserved (borderline 41%–49% and totally =50%) LVEF is considered an important clinical and pathophysiologic distinction in the evaluation of patients presenting with suspected HF. However, this distinction ACR Appropriateness Criteria ® 8 Suspected New-Onset and Known Nonacute Heart Failure is confounded by the following [1]: (1) in most symptomatic HF patients, variable

2018 American College of Radiology

6. High-Sensitivity Cardiac Troponin and New-Onset Heart Failure: A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events.

High-Sensitivity Cardiac Troponin and New-Onset Heart Failure: A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events. The aim of this study was to systematically collate and appraise the available evidence regarding the association between high-sensitivity cardiac troponin (hs-cTn) and incident heart failure (HF) and the added value of hs-cTn in HF prediction.Identification of subjects at high risk for HF and early risk factor modification (...) -analysis.Data were collated from 16 studies with a total of 67,063 subjects and 4,165 incident HF events. The average age was 57 years, and 47% were women. Study quality was high (Newcastle-Ottawa score 8.2 of 9). In a comparison of participants in the top third with those in the bottom third of baseline values of hs-cTn, the pooled multivariate-adjusted HR for incident HF was 2.09 (95% confidence interval [CI]: 1.76 to 2.48; p < 0.001). Between-study heterogeneity was high, with an I2 value of 80%. HRs

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2018 JACC. Heart failure

7. Ottawa Heart Failure Risk Score

Ottawa Heart Failure Risk Score Ottawa Heart Failure Risk Score Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ottawa Heart Failure (...) Risk Score Ottawa Heart Failure Risk Score Aka: Ottawa Heart Failure Risk Score , Ottawa Heart Failure Risk Scale From Related Chapters II. Criteria History Score 1: Stroke or (TIA) Score 2: Intubation for respiratory distress Exam Score 2: on ED arrival >110 bpm Score 1: <90% on arrival Score 1: >110 during 3 minute walk test (or unable to perform) Investigation Score 2: (EKG) with acute ischemic changes Score 1: (BUN) >33.6 mg/dl (12 mmol/L) Score 2: Serum CO2 (or serum bicarbonate) >35 mg/dl

2015 FP Notebook

8. Vasodilators for Inhospital Heart Failure Management

of the Expert Panel for the Update and Integration of the Acute Congestive Heart Failure (CHF) Quality-Based Procedure (QBP), a rapid review was published in 2013 that examined the risk of adverse events associated with vasodilators used for inhospital management of heart failure; in particular, what is the effect on renal function and risk of mortality for patients administered intravenous nitroglycerin or nesiritide in hospital? (1) Researchers found that one RCT comparing nesiritide with placebo met (...) for Inhospital Heart Failure Management: A Rapid Review (Update). February 2015; pp. 1–19 8 Rapid Review Research Question What is the effect of intravenous nesiritide compared with active vasodilators (e.g., dobutamine or nitroglycerin) on renal function and risk of mortality for heart failure inpatients? Research Methods Literature Search The original literature search was revisited in light of an addition to the inclusion and exclusion criteria. The expert panel believed that instead of examining

2015 Health Quality Ontario

9. Aerobic Exercise Training in Patients With Heart Failure

), the results are reported and the rapid review process is complete. If the systematic review has not evaluated the primary studies using GRADE, the primary studies in the systematic review are retrieved and the GRADE criteria are applied to 2 outcomes. If no systematic review is found, then RCTs or observational studies are included, and their risk of bias is assessed. All rapid reviews are developed and finalized in consultation with experts. Aerobic Exercise Training in Patients With Heart Failure (...) Dr Jess Goodman Summerville Family Health Team Staff Physician, Department of Family Practice Nursing Karen Harkness McMaster University, Heart Function Clinic Registered Nurse Clinician Heather Sherrard University of Ottawa Heart Services Vice President, Clinical Services Jan Hoffman London Health Sciences Centre Advanced Practice Nurse Heart Failure Treatment Jane MacIver Toronto General Hospital Nurse Practitioner-Heart Failure and Heart Transplant Program Linda Belford University Health

2015 Health Quality Ontario

10. Vasodilators for Inhospital Heart Failure Management

for Inhospital Management of Heart Failure: A Rapid Review. January 2013; pp. 1–21. 5 List of Abbreviations AMSTAR Assessment of Multiple Systematic Reviews CI Confidence interval(s) CV Cardiovascular HF Heart failure HQO Health Quality Ontario RCT Randomized controlled trial RR Relative risk Vasodilators for Inhospital Management of Heart Failure: A Rapid Review. January 2013; pp. 1–21. 6 Background Objective of Analysis The objective of this analysis was to determine the risk of adverse events associated (...) with vasodilators used for inhospital management of heart failure. In particular, what is the effect on renal function and risk of mortality for patients administered intravenous nitroglycerin or nesiritide in hospital? Clinical Need and Target Population Symptomatic Decompensation of Heart Failure Heart failure (HF) patients who are hospitalized for an acute decompensation may present with symptoms such as volume overload, pulmonary congestion, and dyspnoea. (1) Vasodilators, including nitroglycerin

2013 Health Quality Ontario

11. Early Mobilization and Ambulation in Hospitalized Heart Failure Patients

are high, and the 30-day all-cause risk of readmission (23% for United States Medicare beneficiaries) has remained largely unchanged over time. (5) Heart failure patients also generally have a lengthy hospital stay (intensive or critical care and general medical wards). The median length of stay for hospitalized Canadians with HF is 8 days (interquartile range [IQR] 4–16) for their first admission and 15 days (IQR 7–32) in the following year. (6) Lengthy hospital stays can often result in prolonged (...) , International Society of Cardiomyopathy and Heart Failure of the World Heart Federation Director, National C- CHANGE Program Scientific Director/VP Research, University of Ottawa Heart Institute Professor of Medicine University of Ottawa Heart Institute Dr. Robert McKelvie Professor of Medicine, Cardiologist McMaster University, Hamilton Health Sciences Dr. Malcolm Arnold Professor of Medicine University of Western Ontario, London Health Sciences Centre Dr. Stuart Smith Chief of Cardiovascular Services

2013 Health Quality Ontario

12. Chest X-rays for Diagnosing Pulmonary Infection as a Precipitant of Acute Heart Failure

admissions may in fact be preventable if precipitants are appropriately managed. (3) Upon diagnosis of the precipitating causes of an acute HF event, the course of treatment can be personalized to minimize or eliminate the aggravating source. (4-7) Specifically, pneumococcal pneumonia has been linked to an increased risk for acute cardiac events including new onset or worsening congestive heart failure. (8) This is of particular importance given that pneumonia has been cited as the most common (...) University of Toronto: Department of Medicine, Division of Cardiology, Mount Sinai Hospital Dr. Lisa Mielniczuk Medical Director, Pulmonary Hypertension Clinic University of Ottawa Heart Institute Dr. Peter Liu President, International Society of Cardiomyopathy and Heart Failure of the World Heart Federation / Director, National C-CHANGE Program Scientific Director/VP Research, University of Ottawa Heart Institute / Professor of Medicine, University of Ottawa Heart Institute Dr. Robert McKelvie Professor

2013 Health Quality Ontario

13. A risk scoring system to identify emergency department patients with heart failure at high risk for serious adverse events. (PubMed)

A risk scoring system to identify emergency department patients with heart failure at high risk for serious adverse events. There are no validated guidelines to guide physicians with difficult disposition decisions for emergency department (ED) patients with heart failure (HF). The authors sought to develop a risk scoring system to identify HF patients at high risk for serious adverse events (SAEs).This was a prospective cohort study at six large Canadian EDS that enrolled adult patients who (...) Failure Risk Scale consists of 10 elements, and the risk of SAEs varied from 2.8% to 89.0%, with good calibration between observed and expected probabilities. Internal validation showed the risk scores to be very accurate across 1,000 replications using the bootstrap method. A threshold of 1, 2, or 3 total scores for admission would be associated with sensitivities of 95.2, 80.6, or 64.5%, respectively, all better than current practice.Many HF patients are discharged home from the ED and then suffer

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2013 Academic Emergency Medicine

14. Prediction of Early Adverse Events in Emergency Department Patients With Acute Heart Failure: A Systematic Review.

-term mortality or morbidity in ED patients with AHF. No single risk tool is clearly superior, however, the Emergency Heart Failure Mortality Risk Grade might aid in prognostication of mortality and the Ottawa Heart Failure Risk Score might provide useful prognostic information in patients suitable for ED discharge.Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. (...) Prediction of Early Adverse Events in Emergency Department Patients With Acute Heart Failure: A Systematic Review. Acute heart failure (AHF) accounts for a substantial proportion of Emergency Department (ED) visits and hospitalizations. Previous studies have shown that emergency physicians' clinical gestalt is not sufficient to stratify patients with AHF into severe and requiring hospitalization vs nonsevere and safe to be discharged. Various prognostic algorithms have been developed to risk

2018 The Canadian journal of cardiology

15. National Early Warning Score

in collaboration between nursing staff and the medical team. Recommendation 5 Physiological observations should include: • Respiratory rate • Oxygen saturation - SpO 2 • Heart rate • Blood pressure • Temperature • Level of consciousness • Where a patient is on inspired oxygen (F i O 2 , ) a score of 3 is added. Recommendation 6 In some circumstances, and for some groups of patients, some observations will need to be measured more or less frequently than others, and this should be specified in the monitoring (...) to be relevant to healthcare professionals in acute hospitals nationally who are involved in direct clinical care of adult patients. It is also relevant for hospital managers, risk managers and quality and patient safety personnel. The target group is adult patients in acute hospitals. 18 National Early Warning Score A National Clinical Guideline 3.1 Overview Patient safety and the quality of care are central to the delivery of healthcare. The National Early Warning Score (NEWS) and associated education

2019 National Clinical Guidelines (Ireland)

16. In-Hospital Performance Indicators for In-Hospital Heart Failure Management

; the starting assumption was that randomized controlled trials are high quality, whereas observational studies are low quality. (3) Five additional factors—risk of bias, inconsistency, indirectness, imprecision and publication bias—were then taken into account. Limitations in these areas resulted in downgrading the quality of evidence. Finally, 3 main factors that may raise the In-Hospital Performance Indicators for Heart Failure Management: A Rapid Review. December 2012; pp. 1–20. 8 quality of evidence (...) Evaluative Sciences Dr. Catherine Demers Associate Professor Division of Cardiology, Department of Medicine McMaster University Dr. Susanna Mak Cardiologist University of Toronto: Department of Medicine, Division of Cardiology, Mount Sinai Hospital Dr. Lisa Mielniczuk Medical Director, Pulmonary Hypertension Clinic University of Ottawa Heart Institute Dr. Peter Liu President, International Society of Cardiomyopathy and Heart Failure of the World Heart Federation / Director, National C-CHANGE Program

2012 Health Quality Ontario

17. Intra-Aortic Balloon Pumps for Heart Failure Management

Population Heart failure, a complex condition characterized by impairment of the heart function, may lead to low cardiac output and pulmonary or systemic congestion. (1) The condition is more common in older patients, (1) and therefore its incidence has been increasing with the aging of the population, leading to an increase in the number of hospitalizations for the condition. (2) Acute heart failure presents with a poor prognosis: the risk of death or rehospitalization is estimated to be between 30 (...) Scientist Institute for Clinical Evaluative Sciences Dr. Catherine Demers Associate Professor Division of Cardiology, Department of Medicine McMaster University Dr. Susanna Mak Cardiologist University of Toronto: Department of Medicine, Division of Cardiology, Mount Sinai Hospital Dr. Lisa Mielniczuk Medical Director, Pulmonary Hypertension Clinic University of Ottawa Heart Institute Dr. Peter Liu President, International Society of Cardiomyopathy and Heart Failure of the World Heart Federation

2012 Health Quality Ontario

18. Implantable Cardioverter Defibrillators or Cardiac Resynchronization Therapy for In-Hospital Heart Failure

Evaluative Sciences Dr. Catherine Demers Associate Professor Division of Cardiology, Department of Medicine McMaster University Dr. Susanna Mak Cardiologist University of Toronto: Department of Medicine, Division of Cardiology, Mount Sinai Hospital Dr. Lisa Mielniczuk Medical Director, Pulmonary Hypertension Clinic University of Ottawa Heart Institute Dr. Peter Liu President, International Society of Cardiomyopathy and Heart Failure of the World Heart Federation / Director, National C-CHANGE Program (...) Scientific Director/VP Research, University of Ottawa Heart Institute / Professor of Medicine, University of Ottawa Heart Institute Dr. Robert McKelvie Professor of Medicine, Cardiologist McMaster University, Hamilton Health Sciences Dr. Malcolm Arnold Professor of Medicine Western University, London Health Sciences Centre Dr. Stuart Smith Chief of Cardiovascular Services And Director , Heart Failure Program St. Mary’s General Hospital Dr. Atilio Costa Vitali Assistant Professor of Medicine – Division

2012 Health Quality Ontario

19. Inotropic and Vasoactive Agents for In-Hospital Heart Failure Management

: Literature Search Strategies 14 Appendix 2: GRADE Tables 16 References 17 . Inotropic and Vasoactive Agents for In-Hospital Heart Failure Management: A Rapid Review. December 2012; pp. 1–19. 5 List of Abbreviations AMSTAR Assessment of Multiple Systematic Reviews CI Confidence interval(s) HF Heart failure M-H Mantel-Haenszel test NYHA New York Heart Association RCT Randomized controlled trial RR Relative risk . Inotropic and Vasoactive Agents for In-Hospital Heart Failure Management: A Rapid Review (...) . December 2012; pp. 1–19. 6 Background Objective of Analysis The objective of this analysis was to determine whether there was evidence of increased risk for heart failure (HF) patients who are administered inotropic and vasoactive agents in hospital—in particular, those administered dobutamine, milrinone, or nitroprusside. Clinical Need and Target Population Despite the availability of several effective medical therapies, many patients continue to require hospitalization for acute HF exacerbations

2012 Health Quality Ontario

20. Heart Failure (Multi-Disciplinary Community Care) Clinics Field Evaluation

Semi-structured Interviews 7 Institutional Review Board 8 Results 9 HF Clinic Identification 9 Regional Distribution of HF Clinics 9 Clinic Characteristics 9 Access to Allied Health Professionals 9 Intensity and Complexity 9 Concept Mapping 10 Discussion 11 Table 1: Seed Heart Failure Clinics 13 Table 2: Heart Failure Disease Management Scoring Instrument (HF-DMSI) 14 Table 3: Geographic Distribution of Clinics 15 Table 4: Characteristics of 30 identified clinics 16 Table 5: Clinic Intensity (...) and Complexity 17 Figure 1: Identification of Heart Failure Clinics through Snowball Sampling 18 Figure 2: Geographic Distribution of Heart Failure Clinics 19 Figure 3: Scores on Heart Failure Disease Management Scoring Instrument (HF-DMSI) 20 Appendix A 21 Heart Failure Clinic Stratification using Concept Mapping 21 Chapter 3: Insights into the Contemporary Management of Heart Failure in Specialized Multi- Disciplinary Ambulatory Clinics 23 Objective 24 Methods 25 Clinic Selection 25 Chart Abstraction 25

2011 Health Quality Ontario

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