Yuya Matsue1, Kevin Damman2, Adriaan A Voors2, Nobuyuki Kagiyama3, Tetsuo Yamaguchi4, Shunsuke Kuroda5, Takahiro Okumura6, Keisuke Kida7, Atsushi Mizuno8, Shogo Oishi9, Yasutaka Inuzuka10, Eiichi Akiyama11, Ryuichi Matsukawa12, Kota Kato13, Satoshi Suzuki14, Takashi Naruke15, Kenji Yoshioka16, Tatsuya Miyoshi17, Yuichi Baba18, Masayoshi Yamamoto19, Koji Murai20, Kazuo Mizutani21, Kazuki Yoshida22, Takeshi Kitai23. 1. Department of Cardiology, Kameda Medical Center, Chiba, Japan; University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: yuya8950@gmail.com. 2. University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. 3. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 4. Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan. 5. Department of Cardiology, Kameda Medical Center, Chiba, Japan. 6. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 7. Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan. 8. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. 9. Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan. 10. Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan. 11. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 12. Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan. 13. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 14. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan. 15. Department of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan. 16. Department of Cardiology, Awa Regional Medical Center, Chiba, Japan. 17. Department of Cardiology, Ako City Hospital, Ako, Japan. 18. Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan. 19. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 20. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. 21. Department of Cardiology, Kobe Century Memorial Hospital, Kobe, Japan. 22. Departments of Epidemiology & Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 23. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. OBJECTIVES: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. METHODS: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time <60 min were pre-defined as the early treatment group. Primary outcome was all-cause in-hospital mortality. RESULTS: Among 1,291 AHF patients treated with intravenous furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006). CONCLUSIONS: In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105).
BACKGROUND:Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. OBJECTIVES: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. METHODS: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time <60 min were pre-defined as the early treatment group. Primary outcome was all-cause in-hospital mortality. RESULTS: Among 1,291 AHF patients treated with intravenous furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006). CONCLUSIONS: In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105).
Authors: Alice Kidder Bukhman; Vizir Jean Paul Nsengimana; Mindy C Lipsitz; Patricia C Henwood; Endale Tefera; Shada A Rouhani; Damas Dukundane; Gene Y Bukhman Journal: Curr Cardiol Rep Date: 2019-08-31 Impact factor: 2.931
Authors: Pere Llorens; Patricia Javaloyes; Francisco Javier Martín-Sánchez; Javier Jacob; Pablo Herrero-Puente; Víctor Gil; José Manuel Garrido; Eva Salvo; Marta Fuentes; Héctor Alonso; Fernando Richard; Francisco Javier Lucas; Héctor Bueno; John Parissis; Christian E Müller; Òscar Miró Journal: Clin Res Cardiol Date: 2018-05-04 Impact factor: 5.460