Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure.

Background: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10-20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED.

Methods: We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heart failure. Patients with a cardiology criterion standard diagnosis of decompensated heart failure and an ED diagnosis of decompensated heart failure were compared to patients with a criterion standard of decompensated heart failure but no ED diagnosis of decompensated heart failure.

The combined utility of an S3 heart sound and B-type natriuretic peptide levels in emergency department patients with dyspnea.

Background: Emergency department (ED) patients with undifferentiated dyspnea are a diagnostic dilemma. We hypothesized that electronic detection of an S3 would be more accurate in determining decompensated heart failure than physician auscultation, and that combining electronic heart sounds with B-type natriuretic peptide (BNP) would provide additional decision making information to the emergency physician, especially in the BNP indeterminate range (100-500 pg/mL).

Methods And Results: We collected demographic, clinical, and laboratory data in a convenience sample of ED patients presenting with signs or symptoms of acute decompensated heart failure between September 2003 and June 2004.