Òscar Miró1,2,3, Melissa Hazlitt4, Xavier Escalada5, Pere Llorens6, Víctor Gil7,8, Francisco Javier Martín-Sánchez9, Pia Harjola10, Verónica Rico7,8, Pablo Herrero-Puente11, Javier Jacob12, David C Cone4, Martin Möckel13, Michael Christ14,15, Yonathan Freund16, Salvatore di Somma14,17, Said Laribi14,18, Alexandre Mebazaa14,19, Veli-Pekka Harjola14,10. 1. Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. vgil@clinic.cat. 2. "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain. vgil@clinic.cat. 3. , . vgil@clinic.cat. 4. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. 5. Emergency Medical Services, Barcelona, Spain. 6. Home Hospitalization and Short Stay Unit, Emergency Department, Hospital General de Alicante, Alicante, Spain. 7. Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. 8. "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain. 9. Emergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Madrid, Spain. 10. Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital,, Helsinki University, Helsinki, Finland. 11. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 12. Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 13. Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany. 14. . 15. Department of Emergency and Critical Care Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany. 16. Emergency Department, Hôpital Pitie-Salpêtrière, Sorbonne University, Paris, France. 17. Department of Medical-Surgery Sciences and Translational Medicine Emergency Department Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy. 18. Emergency Medicine Department, School of Medicine and Tours University Hospital, François-Rabelais University, 37044, Tours, France. 19. Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France.
Abstract
OBJECTIVE: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). METHODS: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. RESULTS: We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115-2.811; p = 0.016), and 1.939 (95% CI 1.114-3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. CONCLUSIONS: Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
OBJECTIVE: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). METHODS: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. RESULTS: We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115-2.811; p = 0.016), and 1.939 (95% CI 1.114-3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. CONCLUSIONS:Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
Entities:
Keywords:
Acute heart failure; Advanced life support; Mortality; Outcome; Prehospital care
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