Jin Joo Park1, Sun-Hwa Kim1, Il-Young Oh1, Dong-Ju Choi2, Hyun-Ah Park3, Hyun-Jai Cho4, Hae-Young Lee4, Jae-Yeong Cho5, Kye Hun Kim5, Jung-Woo Son6, Byung-Su Yoo6, Jaewon Oh7, Seok-Min Kang7, Sang Hong Baek8, Ga Yeon Lee9, Jin Oh Choi9, Eun-Seok Jeon9, Sang Eun Lee10, Jae-Joong Kim10, Ju-Hee Lee11, Myeong-Chan Cho11, Se Yong Jang12, Shung Chull Chae12, Byung-Hee Oh4. 1. Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 2. Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: djchoi@snubh.org. 3. Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea. 4. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 5. Heart Research Center of Chonnam National University, Gwangju, Republic of Korea. 6. Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 7. Yonsei University College of Medicine, Seoul, Republic of Korea. 8. Department of Internal Medicine, the Catholic University of Korea, Seoul, Republic of Korea. 9. Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. 10. Division of Cardiology, Asan Medical Center, Seoul, Republic of Korea. 11. Chungbuk National University College of Medicine, Cheongju, Republic of Korea. 12. Kyungpook National University College of Medicine, Daegu, Republic of Korea.
Abstract
OBJECTIVES: This study sought to examine the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED). BACKGROUND: Most patients with AHF present with congestion. Early decongestion with diuretic agents could improve their clinical outcomes. METHODS: The Korea Acute Heart Failure registry enrolled 5,625 consecutive patients hospitalized for AHF. For this analysis, the study included patients who received intravenous diuretic agents within 24 h after ED arrival. Early and delayed groups were defined as D2D time ≤60 min and D2D time >60 min, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time. RESULTS: A total of 2,761 patients met the inclusion criteria. The median D2D time was 128 min (interquartile range: 63 to 243 min), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the post-discharge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes. CONCLUSIONS: The D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843).
OBJECTIVES: This study sought to examine the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED). BACKGROUND: Most patients with AHF present with congestion. Early decongestion with diuretic agents could improve their clinical outcomes. METHODS: The Korea Acute Heart Failure registry enrolled 5,625 consecutive patients hospitalized for AHF. For this analysis, the study included patients who received intravenous diuretic agents within 24 h after ED arrival. Early and delayed groups were defined as D2D time ≤60 min and D2D time >60 min, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time. RESULTS: A total of 2,761 patients met the inclusion criteria. The median D2D time was 128 min (interquartile range: 63 to 243 min), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the post-discharge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes. CONCLUSIONS: The D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843).
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