Òscar Miró1,2, V Íctor Gil3, Francisco Javier Martín-Sánchez4, Javier Jacob5, Pablo Herrero6, Aitor Alquézar7, Lluís Llauger8, Sira Aguiló3, Gemma Martínez3, José Ríos9,10, Alberto Domínguez-Rodríguez11, Veli-Pekka Harjola12, Christian Müller13, John Parissis14, W Frank Peacock15, Pere Llorens16,17. 1. Emergency Department, Hospital Clínic, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain. omiro@clinic.cat. 2. Medical School, University of Barcelona, Barcelona, Catalonia, Spain. omiro@clinic.cat. 3. Emergency Department, Hospital Clínic, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain. 4. Emergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Madrid, Spain. 5. Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. 6. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 7. Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain. 8. Emergency Department, Hospital Universitari de Vic, Barcelona, Catalonia, Spain. 9. Laboratory of Biostatistics and Epidemiology, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain. 10. Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Catalonia, Spain. 11. Cardiology Department, Hospital Universitario de Canarias and Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Santa Cruz de Tenerife, Spain. 12. Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland. 13. Cardiology Department, Hospital University of Basel, Basel, Switzerland. 14. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece. 15. Emergency Department, Baylor College of Medicine, Houston, TX, USA. 16. Home Hospitalization and Short Stay Unit, Emergency Department, Hospital General de Alicante, Alicante, Spain. 17. Medical School, Miguel Hernandez University, Elche, Alicante, Spain.
Abstract
AIMS: To compare short-term outcomes after an episode of acute heart failure (AHF) in patients with reduced and preserved ejection fractions (HFrEF, < 40%; and HFpEF, > 49%; respectively) according to their destinations after emergency department (ED) care. METHODS AND RESULTS: This secondary analysis of the EAHFE Registry (consecutive AHF patients diagnosed in 41 Spanish EDs) investigated 30-day all-cause mortality, in-hospital all-cause mortality, prolonged hospitalisation (> 7 days), and 30-day post-discharge ED revisit due to AHF, all-cause death, and combined endpoint (ED revisit/death) in 5829 patients with echocardiographically documented HFrEF and HfpEF (HFrEF/HFpEF: 1,442/4,387). Adjusted ratios were calculated for patients admitted to internal medicine (IM), short stay unit (SSU), and discharged from the ED without hospitalisation (DEDWH) and compared with those admitted to cardiology. For HFrEF, the only significant differences were lower in-hospital mortality (OR = 0.26; 95% CI 0.08-0.81; p = 0.021) and prolonged hospitalisation (OR = 0.07; 95% CI 0.04-0.13; p < 0.001) related to SSU admission. For HFpEF, IM admission had a higher post-discharge 30-day mortality (HR = 1.85; 95% CI 1.05-3.25; p = 0.033) and combined endpoint (HR = 1.24; 95% CI 1.01-1.64; p = 0.044); SSU admission had a lower in-hospital mortality (OR = 0.43; 95% CI 0.23-0.80; p = 0.008) and prolonged hospitalisation (OR = 0.17; 95% CI 0.13-0.23; p < 0.001) but a higher post-discharge 30-day combined endpoint (HR = 1.29; 95% CI 1.01-1.64; p = 0.041); and DEDDWH had a lower 30-day mortality (HR = 0.46; 95% CI 0.28-0.75; p = 0.002) but higher post-discharge ED revisit (HR = 1.62; 95% CI 1.31-2.00; p < 0.001). CONCLUSION: While HFrEF patients have similar short-term outcomes irrespective of the destination after ED care for an AHF episode, HFpEF patients present worse short-term outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.
AIMS: To compare short-term outcomes after an episode of acute heart failure (AHF) in patients with reduced and preserved ejection fractions (HFrEF, < 40%; and HFpEF, > 49%; respectively) according to their destinations after emergency department (ED) care. METHODS AND RESULTS: This secondary analysis of the EAHFE Registry (consecutive AHF patients diagnosed in 41 Spanish EDs) investigated 30-day all-cause mortality, in-hospital all-cause mortality, prolonged hospitalisation (> 7 days), and 30-day post-discharge ED revisit due to AHF, all-cause death, and combined endpoint (ED revisit/death) in 5829 patients with echocardiographically documented HFrEF and HfpEF (HFrEF/HFpEF: 1,442/4,387). Adjusted ratios were calculated for patients admitted to internal medicine (IM), short stay unit (SSU), and discharged from the ED without hospitalisation (DEDWH) and compared with those admitted to cardiology. For HFrEF, the only significant differences were lower in-hospital mortality (OR = 0.26; 95% CI 0.08-0.81; p = 0.021) and prolonged hospitalisation (OR = 0.07; 95% CI 0.04-0.13; p < 0.001) related to SSU admission. For HFpEF, IM admission had a higher post-discharge 30-day mortality (HR = 1.85; 95% CI 1.05-3.25; p = 0.033) and combined endpoint (HR = 1.24; 95% CI 1.01-1.64; p = 0.044); SSU admission had a lower in-hospital mortality (OR = 0.43; 95% CI 0.23-0.80; p = 0.008) and prolonged hospitalisation (OR = 0.17; 95% CI 0.13-0.23; p < 0.001) but a higher post-discharge 30-day combined endpoint (HR = 1.29; 95% CI 1.01-1.64; p = 0.041); and DEDDWH had a lower 30-day mortality (HR = 0.46; 95% CI 0.28-0.75; p = 0.002) but higher post-discharge ED revisit (HR = 1.62; 95% CI 1.31-2.00; p < 0.001). CONCLUSION: While HFrEF patients have similar short-term outcomes irrespective of the destination after ED care for an AHF episode, HFpEF patients present worse short-term outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.
Authors: Fernando Richard Espiga; Josep María Mòdol Deltell; Francisco Javier Martín-Sánchez; Abel Fernández Sierra; Cristina Fernández Pérez; Antoni Juan Pastor Journal: Emergencias Date: 2017-06 Impact factor: 3.881
Authors: John J V McMurray; Stamatis Adamopoulos; Stefan D Anker; Angelo Auricchio; Michael Böhm; Kenneth Dickstein; Volkmar Falk; Gerasimos Filippatos; Cândida Fonseca; Miguel Angel Gomez-Sanchez; Tiny Jaarsma; Lars Køber; Gregory Y H Lip; Aldo Pietro Maggioni; Alexander Parkhomenko; Burkert M Pieske; Bogdan A Popescu; Per K Rønnevik; Frans H Rutten; Juerg Schwitter; Petar Seferovic; Janina Stepinska; Pedro T Trindade; Adriaan A Voors; Faiez Zannad; Andreas Zeiher Journal: Eur Heart J Date: 2012-05-19 Impact factor: 29.983
Authors: P Bellotti; L P Badano; N Acquarone; R Griffo; G Lo Pinto; A P Maggioni; C Mattiauda; G Menardo; P Mombelloni Journal: Eur Heart J Date: 2001-04 Impact factor: 29.983
Authors: K J Harjai; L M Boulos; F W Smart; T Turgut; M A Krousel-Wood; D D Stapleton; M R Mehra; J P Murgo; H O Ventura Journal: Am J Cardiol Date: 1998-07-01 Impact factor: 2.778
Authors: Douglas S Lee; Michael J Schull; David A Alter; Peter C Austin; Andreas Laupacis; Alice Chong; Jack V Tu; Thérèse A Stukel Journal: Circ Heart Fail Date: 2010-01-27 Impact factor: 8.790
Authors: Piotr Ponikowski; Adriaan A Voors; Stefan D Anker; Héctor Bueno; John G F Cleland; Andrew J S Coats; Volkmar Falk; José Ramón González-Juanatey; Veli-Pekka Harjola; Ewa A Jankowska; Mariell Jessup; Cecilia Linde; Petros Nihoyannopoulos; John T Parissis; Burkert Pieske; Jillian P Riley; Giuseppe M C Rosano; Luis M Ruilope; Frank Ruschitzka; Frans H Rutten; Peter van der Meer Journal: Eur Heart J Date: 2016-05-20 Impact factor: 29.983
Authors: Simon G Anderson; Ahmad Shoaib; Phyo Kyaw Myint; John G Cleland; Suzanna M Hardman; Theresa A McDonagh; Henry Dargie; Bernard Keavney; Clifford J Garratt; Mamas A Mamas Journal: Clin Res Cardiol Date: 2019-04-08 Impact factor: 5.460
Authors: Ahmad Shoaib; M Farag; J Nolan; A Rigby; A Patwala; M Rashid; C S Kwok; R Perveen; A L Clark; M Komajda; J G F Cleland Journal: Clin Res Cardiol Date: 2018-10-25 Impact factor: 5.460