Ana García Sarasola1, Miguel Alberto Rizzi2, Aitor Alquezar Arbé1, Sergio Herrera Mateo1, Víctor Gil3, Pere Llorens4, Javier Jacob5, Francisco Javier Martín-Sánchez6, Pablo Herrero Puente7, Rosa Escoda3, Begoña Espinosa4, Àlex Roset5, Raquel Torres-Gárate8, José Torres-Murillo9, Ana B Mecina10, María Pilar López-Díez11, José María Álvarez Pérez11, Josep Tost12, Eva Salvo13, María Luisa López-Grima14, Cristina Gil15, María Mir16, Frank Rutzinska15, Ovidiu Chioncel16, Òscar Miró3. 1. Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain. 2. Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain. MRizzi@santpau.cat. 3. Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Spain. 4. Emergency Department, Short Stay Unit and Hospitalization at Home, Hospital General de Alicante, Miguel Hernandez University, Alicante, Spain. 5. Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain. 6. Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain. 7. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 8. Emergency Department, Hospital Universitario Severo Ochoa de Leganés, Madrid, Spain. 9. Emergency Department, Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain. 10. Emergency Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 11. Emergency Department, Hospital Universitario de Burgos, Burgos, Spain. 12. Emergency Department, Hospital de Terrassa, Barcelona, Spain. 13. Emergency Department, Hospital Universitario La Fe, Valencia, Spain. 14. Emergency Department, Hospital Doctor Peset, Valencia, Spain. 15. Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain. 16. Emergency Department, Hospital Infanta Leonor, Madrid, Spain.
Abstract
OBJECTIVE: To identify patients at risk of in-hospital mortality and adverse outcomes during the vulnerable post-discharge period after the first acute heart failure episode (de novo AHF) attended at the emergency department. METHODS: This is a secondary review of de novo AHF patients included in the prospective, multicentre EAHFE (Epidemiology of Acute Heart Failure in Emergency Department) Registry. We included consecutive patients with de novo AHF, for whom 29 independent variables were recorded. The outcomes were in-hospital all-cause mortality and all-cause mortality and readmission due to AHF within 90 days post-discharge. A follow-up check was made by reviewing the hospital medical records and/or by phone. RESULTS: We included 3422 patients. The mean age was 80 years, 52.1% were women. The in-hospital mortality was 6.9% and was independently associated with dementia (OR = 2.25, 95% CI = 1.62-3.14), active neoplasia (1.97, 1.41-2.76), functional dependence (1.58, 1.02-2.43), chronic treatment with beta-blockers (0.62, 0.44-0.86) and severity of decompensation (6.38, 2.86-14.26 for high-/very high-risk patients). The 90-day post-discharge combined endpoint was observed in 19.3% of patients and was independently associated with hypertension (HR = 1.40, 1.11-1.76), chronic renal insufficiency (1.23, 1.01-1.49), heart valve disease (1.24, 1.01-1.51), chronic obstructive pulmonary disease (1.22, 1.01-1.48), NYHA 3-4 at baseline (1.40, 1.12-1.74) and severity of decompensation (1.23, 1.01-1.50; and 1.64, 1.20-2.25; for intermediate and high-/very high-risk patients, respectively), with different risk factors for 90-day post-discharge mortality or rehospitalisation. CONCLUSIONS: The severity of decompensation and some baseline characteristics identified de novo AHF patients at increased risk of developing adverse outcomes during hospitalisation and the vulnerable post-discharge phase, without significant differences in these risk factors according to patient age at de novo AHF presentation.
OBJECTIVE: To identify patients at risk of in-hospital mortality and adverse outcomes during the vulnerable post-discharge period after the first acute heart failure episode (de novo AHF) attended at the emergency department. METHODS: This is a secondary review of de novo AHF patients included in the prospective, multicentre EAHFE (Epidemiology of Acute Heart Failure in Emergency Department) Registry. We included consecutive patients with de novo AHF, for whom 29 independent variables were recorded. The outcomes were in-hospital all-cause mortality and all-cause mortality and readmission due to AHF within 90 days post-discharge. A follow-up check was made by reviewing the hospital medical records and/or by phone. RESULTS: We included 3422 patients. The mean age was 80 years, 52.1% were women. The in-hospital mortality was 6.9% and was independently associated with dementia (OR = 2.25, 95% CI = 1.62-3.14), active neoplasia (1.97, 1.41-2.76), functional dependence (1.58, 1.02-2.43), chronic treatment with beta-blockers (0.62, 0.44-0.86) and severity of decompensation (6.38, 2.86-14.26 for high-/very high-risk patients). The 90-day post-discharge combined endpoint was observed in 19.3% of patients and was independently associated with hypertension (HR = 1.40, 1.11-1.76), chronic renal insufficiency (1.23, 1.01-1.49), heart valve disease (1.24, 1.01-1.51), chronic obstructive pulmonary disease (1.22, 1.01-1.48), NYHA 3-4 at baseline (1.40, 1.12-1.74) and severity of decompensation (1.23, 1.01-1.50; and 1.64, 1.20-2.25; for intermediate and high-/very high-risk patients, respectively), with different risk factors for 90-day post-discharge mortality or rehospitalisation. CONCLUSIONS: The severity of decompensation and some baseline characteristics identified de novo AHF patients at increased risk of developing adverse outcomes during hospitalisation and the vulnerable post-discharge phase, without significant differences in these risk factors according to patient age at de novo AHF presentation.
Entities:
Keywords:
De novo acute heart failure; Emergency department; Mortality; Rehospitalisation; Risk factors; Vulnerable phase
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