Francisco Javier Martín-Sánchez1, Patricia Parra Esquivel2, Guillermo Llopis García3, Juan González Del Castillo1, Esther Rodríguez Adrada4, Begoña Espinosa5, María Pilar López Díez6, Rodolfo Romero Pareja7, Miguel Alberto Rizzi Bordigoni8, María José Pérez-Durá9, Carlos Bibiano10, Carles Ferrer11, Sira Aguiló12, Enrique Martín Mojarro13, Alfons Aguirre14, Pascual Piñera15, Amanda López-Picado16, Pere Llorens5, Javier Jacob11, Víctor Gil12, Pablo Herrero13, Cristina Fernández Pérez17, Pedro Gil18, Elpidio Calvo19, Xavier Rosselló20, Héctor Bueno21, Guillermo Burillo2, Òscar Miró12. 1. Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. 2. Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España. 3. Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. 4. Servicio de Urgencias, Hospital Rey Juan Carlos, Móstoles, Madrid, España. 5. Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España. 6. Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Burgos, Burgos, España. 7. Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, España. 8. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 9. Unidad de Corta Estancia, Hospital La Fe, Valencia, España. 10. Servicio de Urgencias, Hospital Universitario Infanta Leonor, Vallecas, Madrid, España. 11. Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. 12. Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España. 13. Servicio de Urgencias, Hospital de Santa Tecla, Tarragona, España. 14. Servicio de Urgencias, Hospital del Mar, Barcelona, España. 15. Servicio de Urgencias, Hospital Reina Sofía, Murcia, España. 16. Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. 17. Servicio de Medicina Preventiva, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Enfermería, Universidad de Enfermería, Madrid, España. 18. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Geriatría, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. 19. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), España. 20. Servicio de Cardiología, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, España. 21. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España.
Abstract
OBJECTIVES: To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. MATERIAL AND METHODS: Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. RESULTS: We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%). CONCLUSION: Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis.
OBJECTIVES: To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. MATERIAL AND METHODS: Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. RESULTS: We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%). CONCLUSION: Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis.
Authors: Òscar Miró; Miguel Benito-Lozano; Pedro Lopez-Ayala; Sergio Rodríguez; Pere Llorens; Ana Yufera-Sanchez; Javier Jacob; Lissete Traveria; Ivo Strebel; Víctor Gil; Josep Tost; Maria de Los Angeles López-Hernández; Aitor Alquézar-Arbé; Begoña Espinosa; Christian Mueller; Guillermo Burillo-Putze Journal: J Gen Intern Med Date: 2022-08-08 Impact factor: 6.473
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: Josep Masip; Marina Povar-Echeverría; William Frank Peacock; Javier Jacob; Víctor Gil; Pablo Herrero; Pere Llorens; Aitor Alquézar-Arbé; Carolina Sánchez; Francisco Javier Martín-Sánchez; Òscar Miró Journal: Intern Emerg Med Date: 2022-03-29 Impact factor: 5.472