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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Lori Daniels, The University of California, USA
- Second opponent: Associate Professor Paul Welsh, University of Glasgow,
- Third member and chair of the evaluation committee: Adjunct Professor Ingrid Nermoen, University of Oslo
Chair of the Defence
Professor II Anne Negård, University of Oslo
Principal Supervisor
Associate Professor Magnus Nakrem Lyngbakken, University of Oslo
Summary
Heart failure (HF) affects one in five people during their lifetime and is a leading cause of hospitalization in Norway. However, diagnosing acute HF can be challenging as symptoms overlap with other conditions. Studies indicate that up to half of all HF patients remain undiagnosed. Patients may also present at emergency departments with multiple causes of dyspnea, and comorbid pneumonia is seen in as many as 20% of patients hospitalized with acute HF.
In his thesis “Diagnostic and prognostic assessment in patients with acute heart failure and acute dyspnea”, Kristian Berge and colleagues addresses both diagnostic and prognostic challenges in acute HF.
In their first paper, they found that the blood biomarker procalcitonin is accurate in identifying bacterial pneumonia in HF patients. This is of importance, as common biomarkers used to diagnose bacterial infections are less accurate among patients with acute HF. Utilizing procalcitonin might reduce the overuse of antibiotics and shorten hospital stays.
In the second paper, they found that cardiac troponin T, a cardiac damage marker most often used to diagnose acute myocardial infarctions, had a strong association with acute HF. The diagnostic utility was particularly useful for HF patients with preserved ejection fraction (HFpEF), as the gold standard biomarker for HF, NT-proBNP, had a lower diagnostic accuracy for HFpEF compared to HF patients with reduced ejection fraction (HFrEF).
In the final paper, they examined whether National Early Warning Score (NEWS) 2, a clinical scoring system, could predict long-term survival for patients with acute HF. The results showed that NEWS2 had high prognostic accuracy for patients with HFpEF but not for HFrEF. Utilization of NEWS2 measured at hospital admission can help clinicians identify HFpEF patients at high risk who might benefit from early follow-up consultations and more aggressive and faster up-titration of medical therapy.
Additional information
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