Early management of stroke patients in the emergency department.

Stroke continues to be one of the leading causes of death and adult disability. Increasing public awareness of stroke has led to a rise in the number of patients presenting to emergency departments (EDs) who qualify for emergent and time-sensitive treatments such as t-PA, clot extraction, and surgery. Timely treatment and supportive care of the stroke patient in the ED is crucial for patient outcomes. Emergency medicine (EM) pharmacists are the medication experts and can have a significant impact on the care of a stroke patient. Thus, it is essential for EM pharmacists to have a solid knowledge of the current guidelines and evidence-based literature or lack there of. In this article, we describe the epidemiology of stroke, review the classifications of stroke, and discuss the present treatment strategies for emergent and supportive care.

Complementary role of copeptin and high-sensitivity troponin in predicting outcome in patients with stable chronic heart failure.

AIMS: Copeptin, the C-terminal part of the vasopressin pro-hormone, is elevated after myocardial infarction and predicts adverse outcome. In the present study we investigated whether the complementary role of copeptin and cardiac troponin T (cTnT) could be used for identification of high-risk patients with chronic stable heart failure. METHODS AND RESULTS: We measured copeptin and high-sensitivity cTnT (hs-cTnT) levels in 172 consecutive patients with stable chronic heart failure. Patients were followed for all-cause mortality and hospitalization due to heart failure for a median of 1301 days (interquartile range: 707-1636). In univariate analysis, plasma copeptin showed a moderate but significant correlation with hs-cTnT (r= 0.40 P< 0.001), age (r= 0.36 P< 0.001), creatinine (r= 0.52 P< 0.001), and amino-terminal pro-B type natriuretic peptide (NT-proBNP; r= 0.42 P< 0.001). Both copeptin (P= 0.002) and hs-cTnT (P= 0.005) concentrations were significantly increased in patients with higher New York Heart Association classes. While 109 (58%) patients had hs-cTnT concentrations above normal (>14 pg/mL) 104 patients (55%) had copeptin concentrations above normal (16.4 pmol/L). In survival analysis, both elevated copeptin and hs-cTnT concentrations were significant predictors of outcome (P< 0.001 for both). The combination of both markers showed a graded and highly significant association with impaired clinical outcome, which was independent of plasma NT-proBNP levels (adjusted hazard ratios 1.40, 95% CI, 1.20-1.70; P< 0.001). Adding copeptin concentrations to a prediction model with NT-proBNP and hs-cTnT resulted in significant improvement in model performance (net reclassification improvement 0.208; P< 0.05). CONCLUSION: Our data suggest that the combined use of hs-cTnT and copeptin might predict clinical outcome of patients with chronic stable heart failure.