Assessing Outcomes in ED Patients With RV Failure
| Status: | Recruiting |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/9/2017 |
| Start Date: | January 1, 2017 |
| End Date: | December 31, 2019 |
| Contact: | Frances Russell, MD |
| Email: | framruss@iu.edu |
Implementation of a Clinical Pathway to Improve Outcomes in Emergency Department Patients With Right Ventricular Failure
Millions of Americans seek emergency care for acute shortness of breath, and many undergo
computerized tomographic pulmonary angiography (CTPA) testing that is negative for acute
disease. Management of patients with persistent shortness of breath despite normal testing
continues to pose a challenge for clinicians. Right ventricular (RV) failure is a common
cause of dyspnea that brings patients to the emergency department (ED), however, it is often
not considered in the differential diagnosis, remains unrecognized, or patients are not
properly followed up once diagnosed. Delays in diagnosis and management of RV failure are
associated with poor outcomes. The investigators propose a novel clinical pathway, which
entails identifying and enrolling patients with RV failure in the ED, then referring them to
a specialized cardiovascular clinic where they will receive a standardized evaluation and
management plan. Our hypothesis is that management of RV failure, through this pathway, will
improve patient outcomes when compared to standard care. The primary outcome will assess
1-year unscheduled healthcare visits.
computerized tomographic pulmonary angiography (CTPA) testing that is negative for acute
disease. Management of patients with persistent shortness of breath despite normal testing
continues to pose a challenge for clinicians. Right ventricular (RV) failure is a common
cause of dyspnea that brings patients to the emergency department (ED), however, it is often
not considered in the differential diagnosis, remains unrecognized, or patients are not
properly followed up once diagnosed. Delays in diagnosis and management of RV failure are
associated with poor outcomes. The investigators propose a novel clinical pathway, which
entails identifying and enrolling patients with RV failure in the ED, then referring them to
a specialized cardiovascular clinic where they will receive a standardized evaluation and
management plan. Our hypothesis is that management of RV failure, through this pathway, will
improve patient outcomes when compared to standard care. The primary outcome will assess
1-year unscheduled healthcare visits.
Inclusion Criteria:
- adult patients > 18 years old,
- with a non-significant CTPA scan (i.e. no acute disease), dyspnea PLUS an emergency
physician performed echocardiogram with isolated RV failure OR CTPA scan with
evidence of pulmonary hypertension OR comprehensive echocardiogram within 3 months of
index hospital visit showing isolated RV dysfunction
Exclusion Criteria:
- Currently being evaluated and/or treated for RV failure or PH,
- those unable to have a comprehensive echocardiography performed,
- those with indeterminate RV function OR LV dysfunction on comprehensive
echocardiography, and
- those patients with circumstances where they may be lost to follow-up (homeless,
prisoner, severe psychiatric disorder, no reliable contact information).
We found this trial at
1
site
Click here to add this to my saved trials
