Òscar Miró1,2, Ana García Sarasola3, Carolina Fuenzalida1, Sofía Calderón1, Javier Jacob4, Alfons Aguirre5, Da M Wu1,6, Miguel A Rizzi3, Pierre Malchair4, Antonio Haro4, Sergio Herrera2, Víctor Gil1, Francisco J Martín-Sánchez7,8, Pere Llorens9, Pablo Herrero Puente10, Héctor Bueno8,11, Alberto Domínguez Rodríguez12, Christian E Müller2,13, Alexandre Mebazaa2,14, Ovidiu Chioncel15, Aitor Alquézar-Arbé3. 1. Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain. 2. The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network. 3. Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain. 4. Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 5. Emergency Department, Hospital del Mar, Barcelona, Spain. 6. San Juan Bautista School of Medicine, San Juan de Puerto Rico, Puerto Rico. 7. Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain. 8. Centro Nacionalde Investigaciones Cardiovasculares (CNIC), Madrid, Spain. 9. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 10. Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain. 11. Cardiology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain. 12. Cardiology Department, Hospital Universitario de Canarias, Tenerife, Spain. 13. Cardiology Department, University Hospital of Basel, Basel, Switzerland. 14. Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France. 15. Emergency Institute for Cardiovascular Diseases, Prof. C. C. Iliescu, University of Medicine Carol Davila, Bucharest, Romania.
Abstract
OBJECTIVES: We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. METHODS AND RESULTS: We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78). CONCLUSION: In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.
OBJECTIVES: We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. METHODS AND RESULTS: We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78). CONCLUSION: In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.
Authors: Miguel Benito-Lozano; Pedro López-Ayala; Sergio Rodríguez; Víctor Gil; Pere Llorens; Ana Yufera; Javier Jacob; Lissete Travería-Becker; Ivo Strebel; Francisco Javier Lucas-Imbernon; Josep Tost; Ángeles López-Hernández; Beatriz Rodríguez; Marta Fuentes; Susana Sánchez-Ramón; Sergio Herrera-Mateo; Alfons Aguirre; M Isabel Alonso; José Pavón; M Luisa López-Grima; Begoña Espinosa; Christian Mueller; Guillermo Burillo-Putze; Òscar Miró Journal: Intern Emerg Med Date: 2022-09-01 Impact factor: 5.472
Authors: Òscar Miró; Xavier Rossello; Elke Platz; Josep Masip; Danielle M Gualandro; W Frank Peacock; Susanna Price; Louise Cullen; Salvatore DiSomma; Mucio Tavares de Oliveira; John Jv McMurray; Francisco J Martín-Sánchez; Alan S Maisel; Christiaan Vrints; Martin R Cowie; Héctor Bueno; Alexandre Mebazaa; Christian Mueller Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-08