{"id":739,"date":"2017-08-14T19:38:56","date_gmt":"2017-08-14T19:38:56","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=739"},"modified":"2020-07-22T00:10:39","modified_gmt":"2020-07-22T00:10:39","slug":"diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/","title":{"rendered":"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis"},"content":{"rendered":"<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<h2 style=\"text-align: center;\">Background<\/h2>\n<p style=\"text-align: center;\">The chief complaint of \u201cdyspnea\u201d represents a very large cohort of patient who present to the emergency department. While acute heart failure (AHF) is a very common diagnosis in the setting of dyspnea, the diagnosis remains challenging when the emergency physician is presented with the undifferentiated dyspneic patient. Interestingly, emergency physicians have varied approaches to the work up and diagnosis of these patients and it is not clear as to which diagnostic element is most crucial in confirming the diagnosis of AHF.\u00a0<em>Spoiler<\/em>: Ultrasound proves to be quite useful.<\/p>\n<h4 style=\"text-align: center;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26910112\" target=\"_blank\" rel=\"noopener noreferrer\">Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis\u200c<\/a><\/h4>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>Clinical Question<\/h3><div>\n<p style=\"text-align: center;\">What are the operating characteristics of the diagnostic elements available to the emergency physician for diagnosing acute heart failure?<\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Methods &amp; Study Design <\/h3><div>\n<ul>\n<li class=\"li1\"><span class=\"s2\"><b>Design<\/b><\/span>\n<ul>\n<li>This is a systematic review evaluating index test operating characteristics in diagnosing AHF. A medical literature search was performed using PubMed and EMBASE, evaluating peer-reviewed published papers from 1965 through 2015<\/li>\n<li>Individual systematic reviews for each index test were conducted by two separate physicians and thereafter reconciled to obtain a comprehensive set of studies on the topic. These were then screened against the inclusion\/exclusion criteria for final inclusion into the meta-analysis<\/li>\n<li>The reference standard used was a final diagnosis of AHF based on review of clinical data by independent reviewers who were blinded to the study\u2019s primary index test<\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s2\"><b>Population<\/b><\/span>\n<ul>\n<li>All studies included involved patients presenting to the emergency department (ED) with the chief complaint of \u201cdyspnea.\u201d<\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s2\"><b>Outcomes<\/b><\/span>\n<ul>\n<li>Pooled sensitivities, specificities and likelihood ratios (LRs) of index tests for diagnosing acute heart failure in patients presenting to the ED with dyspnea<\/li>\n<li>They specifically looked at the following index tests in evaluation of AHF: history and physical exam, ECG, chest x-ray, BNP and NT-ProBNP, lung ultrasound (US), and bedside echocardiography<\/li>\n<\/ul>\n<\/li>\n<li><strong>Excluded<\/strong>\n<ul>\n<li>Patients presenting to urgent care with dyspnea<\/li>\n<li>Patients with chronic, compensated heart failure<\/li>\n<li>Studies focusing on prognosis or therapeutics and not the diagnosis of AHF<\/li>\n<li>Studies with ultrasound images that were not obtained and interpreted by emergency physicians<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Results<\/h3><div>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-746\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png?resize=525%2C411\" alt=\"\" width=\"525\" height=\"411\" \/><\/p>\n<ul>\n<li class=\"li1\">\n<ul>\n<li class=\"li1\"><span class=\"s2\"><strong>History and Physical<\/strong>: S3 most specific finding for AHF (+LR 4)<\/span><\/li>\n<li class=\"li1\"><span class=\"s2\"><strong>ECG<\/strong>:\u00a0Found to be insensitive and unspecific for diagnosing or ruling out AHF<\/span><\/li>\n<li class=\"li1\"><span class=\"s2\"><strong>CXR<\/strong>: Pulmonary edema was the most specific finding (LR + 4.8). All other imaging findings were insensitive for ruling out heart failure <\/span><\/li>\n<li class=\"li1\"><span class=\"s2\"><strong>BNP and NT-Pro-BNP<\/strong>: Quite sensitive for ruling out AHF at a threshold of 100\/300pg\/dL <\/span><\/li>\n<li class=\"li1\"><strong><span class=\"s2\">Lung Ultrasound<\/span><\/strong><span class=\"s2\">:<\/span>\n<ul>\n<li class=\"li1\"><span class=\"s2\">Presence of &gt;3 B-lines in &gt;2 lung fields is very specific for the presence of AHF<\/span><\/li>\n<li class=\"li1\"><span class=\"s2\">Lack of this also sensitive for ruling out acute heart failure <\/span><\/li>\n<li class=\"li1\"><span class=\"s2\">High inter-rater reliability <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><strong><span class=\"s2\">Bedside Echo <\/span><\/strong>\n<ul>\n<li class=\"li1\"><span class=\"s2\">ED provider evaluation of systolic function had high inter-rater reliability with the ultimate ejection fraction assessed by cardiologists on formal echo <\/span><\/li>\n<li class=\"li1\"><span class=\"s2\">Restricted Mitral Inflow very specific for ruling in diastolic AHF in patients with preserved systolic function <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Strengths &amp; Limitations<\/h3><div>\n<ul>\n<li class=\"li1\"><strong>Strengths<\/strong>\n<ul>\n<li>Very thorough analysis of the operating characteristics of a\u00a0plethora of diagnostic elements and sub-elements available to the emergency physician in diagnosing AHF<\/li>\n<li>Authors didn\u2019t exclude comorbidities, etiology of AHF or if there was an underlying arrhythmia which increased the generalizability of their results<\/li>\n<li>All data was screened and evaluated by two separate physicians<\/li>\n<\/ul>\n<\/li>\n<li><strong>Limitations<\/strong>\n<ul>\n<li>The reference standard was a final diagnosis of AHF made by physicians in retrospective fashion which weakens this as a \u201cgold standard.\u201d<\/li>\n<li>The authors did not specifically evaluate or reconcile whether the heart failure was left or right sided<\/li>\n<li>Each of the tests or test characteristics were assessed in isolation to determine the likelihood of heart failure. The likelihood of AHF when considering multiple index tests was not assessed<\/li>\n<li>As in all large meta-analyses, some spectrum bias may exist as inclusion\/exclusion criteria varied among included studies. However, ome of this heterogeneity is likely countered by the pooled analysis and is unlikely to drastically change the calculated LRs<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Author's Conclusions <\/h3><div>\n<p style=\"text-align: center;\">\"Bedside lung US and echocardiography appear to the most useful tests for affirming the presence of AHF while natriuretic peptides are valuable in excluding the diagnosis.\"<\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Our Conclusions<\/h3><div>\n<p style=\"text-align: center;\">This is one of the most thorough studies available to assess the likelihood that a patient presenting to the emergency department has acute heart failure based on an index test. There are many old standby diagnostic modalities available to emergency physicians including the history, physical exam, and chest x-ray. Unfortunately, these diagnostic elements are relatively non-specific in establishing that a patient\u2019s acute symptoms are likely or unlikely due to heart failure. BNP and NT Pro BNP are quite useful in ruling out heart failure however these tests take time to result. Ultrasound is rapidly becoming a fundamental tool in every emergency physicians tool belt and should be utilized alongside the primary patient assessment in determining the likelihood\u00a0that a patient has heart failure. The presence or absence of B lines (&gt;3 in at least 2 fields) is quite specific for ruling in heart failure and the absence is nearly as sensitive as a normal BNP or NT Pro BNP, too. And in the event of systolic heart failure, echo is a great modality to rapidly assess a patient\u2019s pump function; our interpretation is consistent with the formal result obtained by cardiologists [2].<\/p>\n<p style=\"text-align: center;\">Caution must nevertheless be maintained when evaluating these results. The LRs found in these studies were calculated\u00a0independently of other findings and in reality, the emergency physician takes multiple factors from the history, physical exam, and other diagnostic modalities, to ultimately come to a definitive diagnosis. Essentially, the short answer is that no single test should be taken as definitive in diagnosis of AHF (or any diagnosis for that matter) and the emergency physician should follow a bayesian approach using pre- and post- test probabilities from their fund of knowledge to rule in and rule out cannot miss diagnoses. Lastly, with regards to this study, physicians should be wary about interpreting these results in the context of renal failure primarily but also superimposed pneumonia or underlying concern for pulmonary embolism as these patients were excluded in a number of papers included in this meta-analysis.<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-prvt-449-595bfa801309a mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<h2 style=\"text-align: center;\">The Bottom Line<\/h2>\n<h3 style=\"text-align: center;\">Bedside ultrasound to evaluate for the presence or absence of pulmonary edema should be an integral part of the emergency physicians approach to evaluating patients to the emergency department with undifferentiated dyspnea.<\/h3>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>Authors<\/h3><div>\n<p>This post was written by Matt\u00a0Correia, MD PGY-2\u00a0at UCSD. It was edited by Michael Macias, MD.<\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>References <\/h3><div>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Martindale JL, e. (2017). Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. - PubMed - NCBI . Ncbi.nlm.nih.gov. Retrieved 14 August 2017, from https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26910112<\/li>\n<li>Moore CL, e. (2017). Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. - PubMed - NCBI . Ncbi.nlm.nih.gov. Retrieved 14 August 2017, from https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11874773<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"Background The chief complaint of \u201cdyspnea\u201d represents a very large cohort of patient who present to the emergency department. While acute heart failure (AHF) is a very common diagnosis in the setting of dyspnea, the diagnosis remains challenging when the emergency physician is presented with the undifferentiated dyspneic patient. Interestingly, emergency physicians have varied approaches &hellip; <p class=\"link-more\"><a href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis\"<\/span><\/a><\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[5],"tags":[7,19,12],"class_list":["post-739","post","type-post","status-publish","format-standard","hentry","category-journal-club","tag-echocardiography","tag-heart-failure","tag-shortness-of-breath"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis - UCSD Ultrasound<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis - UCSD Ultrasound\" \/>\n<meta property=\"og:description\" content=\"Background The chief complaint of \u201cdyspnea\u201d represents a very large cohort of patient who present to the emergency department. While acute heart failure (AHF) is a very common diagnosis in the setting of dyspnea, the diagnosis remains challenging when the emergency physician is presented with the undifferentiated dyspneic patient. Interestingly, emergency physicians have varied approaches &hellip; Continue reading &quot;Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis&quot;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/\" \/>\n<meta property=\"og:site_name\" content=\"UCSD Ultrasound\" \/>\n<meta property=\"article:published_time\" content=\"2017-08-14T19:38:56+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-07-22T00:10:39+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png\" \/>\n<meta name=\"author\" content=\"UCSD Ultrasound\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@ucsdsono\" \/>\n<meta name=\"twitter:site\" content=\"@ucsdsono\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"UCSD Ultrasound\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/\"},\"author\":{\"name\":\"UCSD Ultrasound\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#\\\/schema\\\/person\\\/b29066b4104637bc43b8a1c79c2cda34\"},\"headline\":\"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis\",\"datePublished\":\"2017-08-14T19:38:56+00:00\",\"dateModified\":\"2020-07-22T00:10:39+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/\"},\"wordCount\":1144,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2017\\\/08\\\/Screen-Shot-2017-08-14-at-12.27.51-PM.png\",\"keywords\":[\"Echocardiography\",\"Heart Failure\",\"Shortness of Breath\"],\"articleSection\":[\"Journal Club\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/\",\"url\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/\",\"name\":\"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis - UCSD Ultrasound\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2017\\\/08\\\/Screen-Shot-2017-08-14-at-12.27.51-PM.png\",\"datePublished\":\"2017-08-14T19:38:56+00:00\",\"dateModified\":\"2020-07-22T00:10:39+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#primaryimage\",\"url\":\"http:\\\/\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2017\\\/08\\\/Screen-Shot-2017-08-14-at-12.27.51-PM.png\",\"contentUrl\":\"http:\\\/\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2017\\\/08\\\/Screen-Shot-2017-08-14-at-12.27.51-PM.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2017\\\/08\\\/14\\\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#website\",\"url\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/\",\"name\":\"UCSD Ultrasound\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#organization\",\"name\":\"UCSD Ultrasound\",\"url\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/i0.wp.com\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2017\\\/05\\\/Site-Icon.png?fit=500%2C500&ssl=1\",\"contentUrl\":\"https:\\\/\\\/i0.wp.com\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2017\\\/05\\\/Site-Icon.png?fit=500%2C500&ssl=1\",\"width\":500,\"height\":500,\"caption\":\"UCSD Ultrasound\"},\"image\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/x.com\\\/ucsdsono\",\"https:\\\/\\\/www.youtube.com\\\/channel\\\/UCUfU0zba7gBUhMWngISV4lw\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#\\\/schema\\\/person\\\/b29066b4104637bc43b8a1c79c2cda34\",\"name\":\"UCSD Ultrasound\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/17bb7447707466629ca47231e7c8d1bc5b82ab3236e9c578ace4202055df2b2b?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/17bb7447707466629ca47231e7c8d1bc5b82ab3236e9c578ace4202055df2b2b?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/17bb7447707466629ca47231e7c8d1bc5b82ab3236e9c578ace4202055df2b2b?s=96&d=mm&r=g\",\"caption\":\"UCSD Ultrasound\"},\"url\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/author\\\/em-admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis - UCSD Ultrasound","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/","og_locale":"en_US","og_type":"article","og_title":"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis - UCSD Ultrasound","og_description":"Background The chief complaint of \u201cdyspnea\u201d represents a very large cohort of patient who present to the emergency department. While acute heart failure (AHF) is a very common diagnosis in the setting of dyspnea, the diagnosis remains challenging when the emergency physician is presented with the undifferentiated dyspneic patient. Interestingly, emergency physicians have varied approaches &hellip; Continue reading \"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis\"","og_url":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/","og_site_name":"UCSD Ultrasound","article_published_time":"2017-08-14T19:38:56+00:00","article_modified_time":"2020-07-22T00:10:39+00:00","og_image":[{"url":"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png","type":"","width":"","height":""}],"author":"UCSD Ultrasound","twitter_card":"summary_large_image","twitter_creator":"@ucsdsono","twitter_site":"@ucsdsono","twitter_misc":{"Written by":"UCSD Ultrasound","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#article","isPartOf":{"@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/"},"author":{"name":"UCSD Ultrasound","@id":"https:\/\/emultrasound.ucsd.edu\/#\/schema\/person\/b29066b4104637bc43b8a1c79c2cda34"},"headline":"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis","datePublished":"2017-08-14T19:38:56+00:00","dateModified":"2020-07-22T00:10:39+00:00","mainEntityOfPage":{"@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/"},"wordCount":1144,"commentCount":0,"publisher":{"@id":"https:\/\/emultrasound.ucsd.edu\/#organization"},"image":{"@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#primaryimage"},"thumbnailUrl":"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png","keywords":["Echocardiography","Heart Failure","Shortness of Breath"],"articleSection":["Journal Club"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/","url":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/","name":"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis - UCSD Ultrasound","isPartOf":{"@id":"https:\/\/emultrasound.ucsd.edu\/#website"},"primaryImageOfPage":{"@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#primaryimage"},"image":{"@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#primaryimage"},"thumbnailUrl":"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png","datePublished":"2017-08-14T19:38:56+00:00","dateModified":"2020-07-22T00:10:39+00:00","breadcrumb":{"@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#primaryimage","url":"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png","contentUrl":"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/Screen-Shot-2017-08-14-at-12.27.51-PM.png"},{"@type":"BreadcrumbList","@id":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/14\/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/emultrasound.ucsd.edu\/"},{"@type":"ListItem","position":2,"name":"Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis"}]},{"@type":"WebSite","@id":"https:\/\/emultrasound.ucsd.edu\/#website","url":"https:\/\/emultrasound.ucsd.edu\/","name":"UCSD Ultrasound","description":"","publisher":{"@id":"https:\/\/emultrasound.ucsd.edu\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/emultrasound.ucsd.edu\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/emultrasound.ucsd.edu\/#organization","name":"UCSD Ultrasound","url":"https:\/\/emultrasound.ucsd.edu\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/emultrasound.ucsd.edu\/#\/schema\/logo\/image\/","url":"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/05\/Site-Icon.png?fit=500%2C500&ssl=1","contentUrl":"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/05\/Site-Icon.png?fit=500%2C500&ssl=1","width":500,"height":500,"caption":"UCSD Ultrasound"},"image":{"@id":"https:\/\/emultrasound.ucsd.edu\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/x.com\/ucsdsono","https:\/\/www.youtube.com\/channel\/UCUfU0zba7gBUhMWngISV4lw"]},{"@type":"Person","@id":"https:\/\/emultrasound.ucsd.edu\/#\/schema\/person\/b29066b4104637bc43b8a1c79c2cda34","name":"UCSD Ultrasound","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/17bb7447707466629ca47231e7c8d1bc5b82ab3236e9c578ace4202055df2b2b?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/17bb7447707466629ca47231e7c8d1bc5b82ab3236e9c578ace4202055df2b2b?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/17bb7447707466629ca47231e7c8d1bc5b82ab3236e9c578ace4202055df2b2b?s=96&d=mm&r=g","caption":"UCSD Ultrasound"},"url":"https:\/\/emultrasound.ucsd.edu\/index.php\/author\/em-admin\/"}]}},"jetpack_sharing_enabled":true,"jetpack-related-posts":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/posts\/739","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/comments?post=739"}],"version-history":[{"count":12,"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/posts\/739\/revisions"}],"predecessor-version":[{"id":1721,"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/posts\/739\/revisions\/1721"}],"wp:attachment":[{"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/media?parent=739"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/categories?post=739"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/emultrasound.ucsd.edu\/index.php\/wp-json\/wp\/v2\/tags?post=739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}