Dr. W. Frank Peacock from the Cleveland Clinic moderated the topic "Emergency Department Risk Stratification of Suspected Acute Heart Failure" with Drs. Deborah Diercks from the University of California Davis Medical Center, J. Douglas Kirk from the University of California Davis Medical Center, Phillip Levy from Wayne State University, Peter S. Pang from the Northwestern University Feinberg School of Medicine, and Alan Storrow from Vanderbilt University participating.
The discussion focused primarily on:
(1) risk stratification on presentation to the emergency department for patient care and disposition
(2) new tools including biomarkers, physiologic responses and better descriptions of the initial presentation,
(3) the complexities of using blood pressures as an approach for risk stratification,
(4) the use of naturietic peptides in the risk stratification process,
(5) the role of troponin elevation and disposition of the ED patient,
(6) issues surrounding the patient with cardio-renal problems, including neutrophil gelatinase associated lipocalin (NGAL) as a biomarker for renal injury,
(7) using procalcitonin to diagnose heart failure and pneumonia,
(8) research regarding the potential for novel biomarkers, including MR-proADM and copeptin,
(9) the use of lactate as a surrogate for identifying sepsis patients and
(10) the evolving use of echocardiography in the ED.