Short-term outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care
- 28 March 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Research in Cardiology
- Vol. 107 (8), 698-710
- https://doi.org/10.1007/s00392-018-1237-z
Abstract
H To compare short-term outcomes after an episode of acute heart failure (AHF) in patients with reduced and preserved ejection fractions (HFrEF, < 40%; and HFpEF, > 49%; respectively) according to their destinations after emergency department (ED) care. This secondary analysis of the EAHFE Registry (consecutive AHF patients diagnosed in 41 Spanish EDs) investigated 30-day all-cause mortality, in-hospital all-cause mortality, prolonged hospitalisation (> 7 days), and 30-day post-discharge ED revisit due to AHF, all-cause death, and combined endpoint (ED revisit/death) in 5829 patients with echocardiographically documented HFrEF and HfpEF (HFrEF/HFpEF: 1,442/4,387). Adjusted ratios were calculated for patients admitted to internal medicine (IM), short stay unit (SSU), and discharged from the ED without hospitalisation (DEDWH) and compared with those admitted to cardiology. For HFrEF, the only significant differences were lower in-hospital mortality (OR = 0.26; 95% CI 0.08-0.81; p = 0.021) and prolonged hospitalisation (OR = 0.07; 95% CI 0.04-0.13; p < 0.001) related to SSU admission. For HFpEF, IM admission had a higher post-discharge 30-day mortality (HR = 1.85; 95% CI 1.05-3.25; p = 0.033) and combined endpoint (HR = 1.24; 95% CI 1.01-1.64; p = 0.044); SSU admission had a lower in-hospital mortality (OR = 0.43; 95% CI 0.23-0.80; p = 0.008) and prolonged hospitalisation (OR = 0.17; 95% CI 0.13-0.23; p < 0.001) but a higher post-discharge 30-day combined endpoint (HR = 1.29; 95% CI 1.01-1.64; p = 0.041); and DEDDWH had a lower 30-day mortality (HR = 0.46; 95% CI 0.28-0.75; p = 0.002) but higher post-discharge ED revisit (HR = 1.62; 95% CI 1.31-2.00; p < 0.001). While HFrEF patients have similar short-term outcomes irrespective of the destination after ED care for an AHF episode, HFpEF patients present worse short-term outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.Keywords
This publication has 31 references indexed in Scilit:
- Long-term survival after hospitalization for acute heart failure — Differences in prognosis of acutely decompensated chronic and new-onset acute heart failureInternational Journal of Cardiology, 2013
- ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESCEuropean Heart Journal, 2012
- The national heart failure audit for England and Wales 2008-2009Heart, 2010
- Early Deaths in Patients With Heart Failure Discharged From the Emergency DepartmentCirculation: Heart Failure, 2010
- Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other SpecialistsCirculation, 2003
- Specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for heart failure. The OSCUR studyEuropean Heart Journal, 2001
- Resource Use and Survival of Patients Hospitalized with Congestive Heart Failure: Differences in Care by Specialty of the Attending PhysicianAnnals of Internal Medicine, 2000
- Cardiology or Primary Care for Heart Failure in the Community SettingSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1999
- Differences Between Primary Care Physicians and Cardiologists in Management of Congestive Heart Failure: Relation to Practice GuidelinesJournal of the American College of Cardiology, 1997
- Survival after the onset of congestive heart failure in Framingham Heart Study subjects.Circulation, 1993