Emergency Department Management of Hereditary Angioedema Attacks: Patient Perspectives

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• 作者：Iris M. Otani ; MD^a ; ^{iris.otani@ucsf.edu} ; Sandra C. Christiansen ; MD^b ; Paula Busse ; MD^c ; Carlos A. Camargo Jr. ; MD ; DrPH^a ; ^d ; Bruce L. Zuraw ; MD^b ; Marc A. Riedl ; MD ; MS^b ; Aleena Banerji ; MD^a
• 关键词：Hereditary angioedema ; Hereditary angioedema attacks ; Treatment plan ; Angioedema management ; Emergency department ; Angioedema guidelines ; On-demand treatment ; Patient-reported outcomes ; Quality of life ; Disease burden
• 刊名：The Journal of Allergy and Clinical Immunology: In Practice
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：5
• 期：1
• 页码：128-134.e4
• 全文大小：273 K
• 卷排序：5

文摘

Emergency department (ED) management of hereditary angioedema (HAE) has been hindered by misdiagnosis and limited treatment options. Food and Drug Administration approval of 4 on-demand HAE therapies starting in 2009 and the publication of ED guidelines for angioedema management in 2014 should facilitate improvement of HAE management in the ED.ObjectiveThe objective of this study was to identify patient-reported areas for improvement in ED management of HAE attacks.MethodsPatients with self-reported HAE with C1 inhibitor deficiency who attended the 2015 HAE Association Patient Summit were asked to complete an anonymous 30-question survey. Questions addressed patient characteristics and HAE management in the ED.ResultsPatients indicated that understanding of HAE in the ED needed improvement (99%, 104 of 105 patients). Recognition of HAE as a diagnosis (48%, 50 of 105 patients), appreciation of HAE as a serious disease (45%, 47 of 105 patients), and medication management (59%, 62 of 105 patients) were identified as areas needing improvement. Among 39 patients who required ED care within the last year, 6 did not receive any HAE-targeted therapy, and treatment with corticosteroids (n = 3), epinephrine (n = 2), and antihistamines (n = 7) was reported. Among 68 patients whose treatment plan was to receive home on-demand therapy, 26 required ED care because of an inability to receive on-demand therapy at home as outlined in their treatment plan. Having a treatment plan was associated with a greater likelihood of receiving HAE therapy in the ED (99% vs 74%, P = .002).ConclusionHAE management in the ED can be improved with a focus on recognition of HAE attacks and administration of effective HAE therapies.