Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world.

EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing physician.

This episode is... The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing physician.

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We'd like to think that we're getting better at identifying acute heart failure

and making good disposition decisions, but the facts are ED physicians are only about 80%

accurate at diagnosing acute heart failure. And 30-day mortality outcomes and readmission rates

for acute heart failure have been about the same in North America for the last few decades in a row. Plus, we often send home patients who should be admitted

and admit patients who should be sent home. This is because there are many challenges for

EM docs when it comes to heart failure. First, the diagnosis can be tough and often is only made

once the patient is admitted. There is no one clinical feature that's a slam dunk for the diagnosis

and even combinations of features are not so great. Plus, there are many flavors of heart failure.

There's diastolic heart failure, systolic heart failure,

right-sided, left-sided, scape, cardiogenic shock, just to complicate things a bit further.

And even if we've made an accurate diagnosis, the decision of whether to admit or send home

can be very challenging. We have risk stratification decision scales to help, but A, are they good enough?

B, are we using them appropriately?

And C, are they any better than Gestalt?

In this podcast, with the help of Dr. Doug Lee, cardiologist and researcher at Sunnybrook

Hospital and at University Health Network in Toronto, and Dr. Claire Atzma, who you've probably heard before on EM cases, our go-to EM atrial

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