Emergency Department Management of Hereditary Angioedema Attacks: Patient Perspectives.

Abstract

BACKGROUND:

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.

OBJECTIVE:

The objective of this study was to identify patient-reported areas for improvement in ED management of HAE attacks.

METHODS:

Patients 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.

RESULTS:

Patients 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).

CONCLUSION:

HAE management in the ED can be improved with a focus on recognition of HAE attacks and administration of effective HAE therapies.

• Authors: Iris M Otani, Sandra C Christiansen, Paula Busse, Carlos A Camargo Jr, Bruce L Zuraw, Marc A Riedl, Aleena Banerji
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) 2017 Jan - Feb Vol. 5 Issue 1 Pg. 128-134.e4 ISSN: 2213-2201 [Electronic] United States
• PMID: 27665386 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Angioedemas, Hereditary (diagnostic imaging, epidemiology, therapy)
• Child
• Child, Preschool
• Diagnostic Errors
• Disease Management
• Emergency Medical Services
• Emergency Service, Hospital
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Patient Satisfaction
• Practice Guidelines as Topic
• Quality Assurance, Health Care
• Quality Improvement
• Surveys and Questionnaires
• United States
• United States Food and Drug Administration