Toru Kondo1, Takahiro Okumura1, Yuya Matsue2,3, Atsushi Shiraishi4, Nobuyuki Kagiyama5,6, Tetsuo Yamaguchi7, Shunsuke Kuroda8, Keisuke Kida9, Atsushi Mizuno10, Shogo Oishi11, Yasutaka Inuzuka12, Eiichi Akiyama13, Ryuichi Matsukawa14, Kota Kato15, Satoshi Suzuki16, Takashi Naruke17, Kenji Yoshioka18, Tatsuya Miyoshi19, Yuichi Baba20, Masayoshi Yamamoto21, Koji Murai22, Kazuo Mizutani23, Kazuki Yoshida24, Takeshi Kitai25, Toyoaki Murohara1. 1. Department of Cardiology, Nagoya University Graduate School of Medicine. 2. Department of Cardiovascular Medicine, Juntendo University. 3. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Juntendo University School of Medicine. 4. Emergency and Trauma Center, Kameda Medical Center. 5. Division of Cardiology, Washington University in St. Louis. 6. Department of Cardiology, The Sakakibara Heart Institute of Okayama. 7. Department of Cardiology, Japanese Red Cross Musashino Hospital. 8. Department of Cardiology, Kameda Medical Center. 9. Department of Cardiology, St. Marianna University School of Medicine. 10. Department of Cardiology, St. Luke's International Hospital. 11. Department of Cardiology, Himeji Cardiovascular Center. 12. Department of Cardiology, Shiga Medical Center for Adults. 13. Division of Cardiology, Yokohama City University Medical Center. 14. Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital. 15. Department of Cardiology, Tokyo Medical University. 16. Department of Cardiovascular Medicine, Fukushima Medical University. 17. Department of Cardio-angiology, Kitasato University School of Medicine. 18. Department of Cardiology, Awa Regional Medical Center. 19. Department of Cardiology, Ako City Hospital. 20. Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University. 21. Cardiovascular Division, Faculty of Medicine, University of Tsukuba. 22. Department of Cardiovascular Medicine, Nippon Medical School. 23. Department of Cardiology, Kobe Century Memorial Hospital. 24. Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health. 25. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital.
Abstract
BACKGROUND: The aim of this study was to assess specialty-related differences in the treatment for patients with acute heart failure (AHF) in the acute phase and subsequent prognostic differences. Methods and Results: We analyzed hospitalizations for AHF in REALITY-AHF, a multicenter prospective registry focused on very early presentation and treatment in patients with AHF. All patients were classified according to the medical specialty of the physicians responsible for contributed most to decisions regarding the initial diagnosis and treatment after the emergency department (ED) arrival. Patients initially managed by emergency physicians (n=614) or cardiologists (n=911) were analyzed. After propensity-score matching, vasodilators were used less often by emergency physicians than by cardiologists at 90 min after ED arrival (29.8% vs. 46.1%, P<0.001); this difference was also observed at 6, 24, and 48 h. Cardiologists administered furosemide earlier than emergency physicians (67 vs. 102 min, P<0.001). However, the use of inotropes, noninvasive ventilation, and endotracheal intubation were similar between groups. In-hospital mortality did not differ between patients managed by emergency physicians and those managed by cardiologists (4.1% vs. 3.8%, odds ratio 1.12; 95% confidence interval 0.58-2.14). CONCLUSIONS: Despite differences in initial management, no prognostic difference was observed between emergency physicians and cardiologists who performed the initial management of patients with AHF.
BACKGROUND: The aim of this study was to assess specialty-related differences in the treatment for patients with acute heart failure (AHF) in the acute phase and subsequent prognostic differences. Methods and Results: We analyzed hospitalizations for AHF in REALITY-AHF, a multicenter prospective registry focused on very early presentation and treatment in patients with AHF. All patients were classified according to the medical specialty of the physicians responsible for contributed most to decisions regarding the initial diagnosis and treatment after the emergency department (ED) arrival. Patients initially managed by emergency physicians (n=614) or cardiologists (n=911) were analyzed. After propensity-score matching, vasodilators were used less often by emergency physicians than by cardiologists at 90 min after ED arrival (29.8% vs. 46.1%, P<0.001); this difference was also observed at 6, 24, and 48 h. Cardiologists administered furosemide earlier than emergency physicians (67 vs. 102 min, P<0.001). However, the use of inotropes, noninvasive ventilation, and endotracheal intubation were similar between groups. In-hospital mortality did not differ between patients managed by emergency physicians and those managed by cardiologists (4.1% vs. 3.8%, odds ratio 1.12; 95% confidence interval 0.58-2.14). CONCLUSIONS: Despite differences in initial management, no prognostic difference was observed between emergency physicians and cardiologists who performed the initial management of patients with AHF.
Entities:
Keywords:
Acute heart failure; Emergency department; Medical specialty; Prognosis