Pere Llorens1, Patricia Javaloyes1, Francisco Javier Martín-Sánchez2,3, Javier Jacob4, Pablo Herrero-Puente5, Víctor Gil6, José Manuel Garrido7, Eva Salvo8, Marta Fuentes9, Héctor Alonso10, Fernando Richard11, Francisco Javier Lucas12, Héctor Bueno13,14, John Parissis15, Christian E Müller16, Òscar Miró17,18,19. 1. Emergency Department, Short Stay Unit and Hospitalization at Home, ISABIAL-Fundación FISABIO, Hospital Universitario General de Alicante, Alicante, Spain. 2. Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitario Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Madrid, Spain. 3. The GREAT (Global REsearch on Acute conditions Team) Network, Rome, Italy. 4. Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain. 5. Emergency Department, Grupo de Investigación de Urgencias-HUCA, Hospital Universitario Central de Asturias, Oviedo, Spain. 6. "Emergencies: Processes and Pathologies" Research Group, Emergency Department, IDIBAPS, Hospital Clínic, Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. 7. Emergency Department, Hospital Virgen de la Macarena, Seville, Spain. 8. Emergency Department, Hospital Politécnico La Fe, Valencia, Spain. 9. Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain. 10. Emergency Department, Hospital Marqués de Valdecilla, Santander, Spain. 11. Emergency Department, Hospital Universitario de Burgos, Burgos, Spain. 12. Emergency Department, Hospital General de Albacete, Albacete, Spain. 13. Cardiology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain. 14. National Centre for Cardiovascular Research (CNIC), Madrid, Spain. 15. Second Department of Cardiology, University of Athens Medical School, Athens, Greece. 16. Cardiology Department, University Hospital of Basel, Basel, Switzerland. 17. The GREAT (Global REsearch on Acute conditions Team) Network, Rome, Italy. omiro@clinic.cat. 18. "Emergencies: Processes and Pathologies" Research Group, Emergency Department, IDIBAPS, Hospital Clínic, Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. omiro@clinic.cat. 19. School of Medicine, University of Barcelona, Barcelona, Spain. omiro@clinic.cat.
Abstract
OBJECTIVES: To analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007-2016). METHODS: The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries. RESULTS: Compared to other large registries, our patients were older [80 (10) years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6) days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period. CONCLUSIONS: The EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.
OBJECTIVES: To analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007-2016). METHODS: The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries. RESULTS: Compared to other large registries, our patients were older [80 (10) years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6) days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period. CONCLUSIONS: The EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.
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