European Dyspnoea Survey in the EMergency Departments (EuroDEM)

Braunwald defines dyspnoea as an abnormally uncomfortable awareness of breathing. Breathing discomfort, and its varying degrees of severity, is the one of the most disturbing symptoms patients can experience; and it is one of the main complaints in the patients presenting to the Emergency Department (ED). Dyspnea has a variety of underlying etiologies, like cardiac, pulmonary or metabolic etiologies or a combination of them, since several diseases can cause dyspnea like for instance heart failure (HF), asthma and chronic obstructive pulmonary disease (COPD).

Acute heart failure syndrome (AHFS) is collectively defined as a gradual or rapid change in heart failure (HF) signs and symptoms resulting in a need for urgent therapy. Heart failure (HF) is one of the most important causes of morbidity and mortality in the industrialized world. The prevalence of symptomatic HF is estimated to range from 0.4 to 2.0% in general European population. The incidence increases rapidly with age, and in Europe. Characteristics, clinical presentation, treatment, and outcomes of HF patients admitted to hospital have been adequately described, in Europe and in the United States. The Euro Heart Failure Survey (EHFS) I with 11 327 patients described the demographics of acutely hospitalized HF patients. The ADHERE registry has data on over 100 000 hospitalizations for AHF from the USA. In-hospital mortality was 4 and 7%, in ADHERE and EHFS I, respectively.

This same sensation of breathlessness is what also drives patients with asthma and chronic obstructive pulmonary disease (COPD) to the ED. Chronic obstructive pulmonary disease (COPD) exacerbation accounts for approximately 1.5 million ED visits in the United States per year. It is the third most common cause of hospitalization, with an estimated 726 000 hospitalizations in 2000 in the USA. Previous studies have demonstrated important differences between guideline recommendations and actual management of COPD exacerbation, either in the ED or during hospitalization.

The diagnosis in front of a dyspneic patient in the ED remains a challenge, because of a low sensitivity of the clinical signs associated with the aging of the population and the variety of underlying diseases. Little is known about the Epidemiology of dyspneic patients in the ED at the European level. Diagnosis, prevalence and treatment of the patients may vary among European countries.

Study Overview

• Status: Completed
• Conditions: Emergencies; Dyspnea

Detailed Description

MAIN OBJECTIVES

• Epidemiologic description of patients presenting to the ED with shortness of breath as main complaint.
• Description of current management in the ED of patients presenting to the ED with shortness of breath as main complaint.

SECONDARY OBJECTIVES

• Sub analysis of ED discharged patients versus admitted patients for characteristics, comparison to recommended care and re-ED visit.

• Determine clinical and/or biological criteria to distinguish between:

  • Patients who are treated as outpatients and admitted patients.
  • Patients hospitalized in ward and patients admitted to intensive care units (CCU and ICU)
• Prognostic prediction, using clinical and biochemical data
• To determine if ED patients treated for acute heart failure differ from those admitted to hospital.
• Comparison of European data characteristics, investigation, treatment and outcome to similar data in other part of the world.

• Study Type: Observational
• Enrollment (Actual): 2156

Contacts and Locations

Study Locations

• Belgium
  • Brussels, Belgium
    • Country: Belgium
• Finland
  • Helsinki, Finland
    • Country: Finland
• France
  • Paris, France
    • Country: France
• Germany
  • Nuremberg, Germany
    • Country: Germany
• Italy
  • Rome, Italy
    • Country: Italy
• Netherlands
  • Amsterdam, Netherlands
    • Country: Netherlands
• Romania
  • Cluj Napoca, Romania
    • Country: Romania
• Spain
  • Santander, Spain
    • Country: Spain
• Turkey
  • Ankara, Turkey
    • Country: Turkey
• United Kingdom
  • Manchester, United Kingdom
    • Country: United Kingdom

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Consecutive patients presenting to the Emergency Department with Dyspnea as main complaint during the study period.

Description

Inclusion Criteria:

• Consecutive patients presenting to the Emergency Department with Dyspnea as main complaint
• 18 years or older

Exclusion Criteria:

• No acceptance to participate from the patient

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All cause mortality	All cause mortality will be evaluated 30 days after ED visit.	30 days

Secondary Outcome Measures

Outcome Measure	Time Frame
All cause rehospitalization	30 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
ED visit	New ED visit during follow-up	30 days

Collaborators and Investigators

• Sponsor: Hopital Lariboisière
• Investigators: Principal Investigator: Said LARIBI, MD, PhD, Lariboisière Hospital, EuSEM

Study record dates

Study Major Dates

• Study Start: February 1, 2014
• Primary Completion (Actual): March 1, 2014
• Study Completion (Actual): November 1, 2014

Study Registration Dates

• First Submitted: February 9, 2014
• First Submitted That Met QC Criteria: February 9, 2014
• First Posted (Estimate): February 12, 2014

Study Record Updates

• Last Update Posted (Estimate): December 18, 2014
• Last Update Submitted That Met QC Criteria: December 16, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: prognosis; Epidemiology; Emergency Service, Hospital; Dyspnea; Fatal Outcome
• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Respiration Disorders; Disease Attributes; Signs and Symptoms, Respiratory; Emergencies; Dyspnea
• Other Study ID Numbers: HLariboisiere