Abstract
Aims
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.
Methods and results
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).
Conclusion
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.
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References
Lassus JP, Siirilä-Waris K, Nieminen MS, Tolonen J, Tarvasmäki T, Peuhkurinen K et al (2013) Long-term survival after hospitalization for acute heart failure. differences in prognosis of acutely decompensated chronic and new-onset acute heart failure. Int J Cardiol 168:458–462
Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo-Leiro MG et al (2017) Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 19:1242–1254
Peacock WF (2016) When and for how long do patients with acute heat failure have to be admitted? Emergencias 28:363–365
Miró Ò, Levy PD, Möckel M, Pang PS, Lambrinou E, Bueno H et al (2017) Disposition of emergency department patients diagnosed with acute heart failure: an international emergency medicine perspective. Eur J Emerg Med 24:2–12
Jong P, Gong Y, Liu PP, Austin PC, Lee DS, Tu JV (2003) Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation 108:184–191
Cleland JGF, McDonagh T, Rigby AS, Yassin A, Whittaker T, Dargie HJ et al (2011) The national heart failure audit for England and Wales 2008–2009. Heart 97:876–886
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200
Miró Ò, Javaloyes P, Gil V, Jacob J, Herrero-Puente P, Martín-Sánchez FJ et al (2017) Mortality after an episode of acute heart failure in a cohort of patients with intermediate ventricular function: Global analysis and relationship with admission department. Med Clin (Barc). https://doi.org/10.1016/j.medcli.2017.11.025 (press)
Martínez F, Martínez-Ibañez L, Pichler G, Ruiz A, Redon J (2017) Multimorbidity and acute heart failure in internal medicine. Int J Cardiol 232:208–215
Carbajosa V, Martín-Sánchez FJ, Llorens P, Herrero P, Jacob J, Alquézar A et al (2016) Factors associated with short stays for patients admitted with acute heart failure. Emergencias 28:366–374
Miró Ò, Rossello X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero-Puente P et al (2017) Predicting 30-Day Mortality for Patients With Acute Heart Failure in the Emergency Department: A Cohort Study. Ann Intern Med 167:698–705
Miró O, Llorens P, Escalada X, Herrero P, Jacob J, Gil V et al (2017) Analysis of the different factors of prehospital care for patients with acute heart failure in Spain. Emergencias 29:223–230
Ho KKL, Anderson KM, Kannel WB, Grosssman W, Levy D (1993) Survival after the onset of congestive heart failure in Framingham heart study subjects. Circulation 88:107–115
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K et al (2012) 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 ESC. Eur Heart J 33:1787–1847
Harjai KJ, Boulos LM, Smart FW, Turgut T, Krousel-Wood MA, Stapleton DD et al (1998) Effects of caregiver specialty on cost and clinical outcomes following hospitalization for heart failure. Am J Cardiol 82:82–85
Auerbach AD, Hamel MB, Davis RB, Connors AF Jr, Regueiro C, Desbiens N et al (2000) Resource use and survival of patients hospitalized with congestive heart failure: differences in care by specialty of the attending physician. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 132:191–200
Ansari M, Alexander M, Tutar A, Bello D, Massie BM (2003) Cardiology participation improves outcomes in patients with new-onset heart failure in the outpatient setting. J Am Coll Cardiol 41:62–68
Richard Espiga F, Mòdol Deltell JM, Martín-Sánchez FJ, Fernández Sierra A, Fernández Pérez C, Juan Pastor A (2017) Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators. Emergencias 29:147–153
Maggioni AP, Orso F, Calabria S, Rossi E, Cinconze E, Baldasseroni S et al (2016) The real-world evidence of heart failure: findings from 41 413 patients of the ARNO database.Eur. J Heart Fail 18:402–410
Miró Ò, Gil V, Müller C, Mebazaa A, Bueno H, Martín-Sánchez FJ et al (2015) How does a clinical trial fit into the real world? The RELAX-AHF study population into the EAHFE registry. Clin Res Cardiol 104:850–860
Lee DS, Schull MJ, Alter DA, Austin PC, Laupacis A, Chong A, Tu JV, Stukel TA (2010) Early deaths in patients with heart failure discharged from the emergency department: a population-based analysis. Circ Heart Fail 3:228–235
Edep ME, Shah NB, Tateo IM et al (1997) Differences between primary care physicians and cardiologists in management of congestive heart failure: relation to practice guidelines. J Am Coll Cardiol 30:518–526
Bellotti P, Badano LP, Acquarone N et al (2001) Specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for heart failure; the OSCUR study: Oucome dello Scompenso Cardiaco in relazione all’Utilizzo delle Risore. Eur Heart J 22:596–604
Philbin EF, Weil HF, Erb TA et al (1999) Cardiology or primary care for heart failure in the community setting: process of care and clinical outcomes. Chest 116:346–354
Comín-Colet J, Enjuanes C, Lupón J, Cainzos-Achirica M, Badosa N, Verdú JM (2016) Transitions of care between acute and chronic heart failure: critical steps in the design of a multidisciplinary care model for the prevention of rehospitalization. Rev Esp Cardiol 69:951–961
Vedel I, Khanassov V (2015) Transitional care for patients with congestive heart failure: a systematic review and meta-analysis. Ann Fam Med 13:562 – 71
Gandhi S, Mosleh W, Sharma UC, Demers C, Farkouh ME, Schwalm JD (2017) Multidisciplinary heart failure clinics are associated with lower heart failure hospitalization and mortality: systematic review and meta-analysis. Can J Cardiol 33:1237–1244
Miró Ò, Hazlitt M, Escalada X, Llorens P, Gil V, Martín-Sánchez FJ, Harjola P, Rico V, Herrero-Puente P, Jacob J, Cone DC, Möckel M, Christ M, Freund Y, di Somma S, Laribi S, Mebazaa A, Harjola VP (2017) Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study. Clin Res Cardiol. https://doi.org/10.1007/s00392-017-1190-2 (press)
Harjola P, Harjola VP (2017) Can we do more for patients with acute heart failure in the prehospital phase? Emergencias 29:221–222
Acknowledgements
This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/01019 and PI15/00773) and Fundació La Marató de TV3 (2015/2510). The “Emergencies: Processes and Pathologies” research group of the IDIBAPS receives financial support from the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313). We thank Alícia Díaz for her professionalism in data management.
Other investigators of the ICA-SEMES research group: Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca). María José Pérez-Durá, Eva Salvo (Hospital La Fe de Valencia). Carolina Xipell, Carolina Sánchez, Josep M. Gaytan (Hospital Clínic de Barcelona). Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria). José M. Torres (Hospital Reina Sofía de Córdoba). Maria Luisa López-Grima, Amparo Valero (Hospital Dr. Peset de Valencia). Alfons Aguirre, Maria Àngels Pedragosa (Hospital del Mar de Barcelona).Raquel Torres-Gárate (Hospital Severo Ochoa de Leganés, Madrid). María Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla). José Miguel Franco (Hospital Miguel Servet de Zaragoza). Susana Sánchez (Hospital Rio Ortega de Valladolid). Aitor Alquézar, Miguel Alberto Rizzi, Sergio Herrera (Hospital San Pau de Barcelona). Fernando Richard (Hospital de Burgos). Francisco Javier Lucas (Hospital General de Albacete). Irene Cabello, Álex Roset (Hospital Universitari de Bellvitge, Barcelona). José Manuel Garrido (Hospital Virgen de la Macarena, Sevilla). Héctor Alonso (Hospital Marqués de Valdecilla de Santander). Esther Rodríguez Adrada, Guillermo Llopis García (Hospital Clínico San Carlos, Madrid). Fernando Richard, José María Álvarez Pérez, María Pilar López Diez (Hospital Universitario de Burgos). Ana Belén Mecina (Hospital Universitario Fundación Alcorcón, Madrid). Javier Lucas (Hospital General de Albacete). Joaquín Vázquez Álvarez, Marta Sánchez González, Belén Prieto, María García García (Hospital Universitario Central de Asturias). Víctor Marquina, Inmaculada Jiménez, Patricia Javaloyes, Néstor Hernández, Benjamin Brouzet, Ana López (Hospital General de Alicante). Juan Antonio Andueza (Hospital General Universitario Gregorio Marañón de Madrid), Rodolfo Romero (Hospital Getafe de Madrid). Roberto Calvache (Hospital de Henares de Madrid), María Teresa Lorca, Luis Calderón (Hospital del Tajo de Madrid)Beatriz Amores Arriaga, Beatriz Sierra (Hospital Clínico Lozano Blesa de Zaragoza), Pascual Piñera, José Andrés Sñanchez Nicolás (Hospital General Universitario Reina Sofía de Murcia), Enrique Martín Mojarro (Hospital Sant Pau i Santa Tecla de Tarragona), Lisette Travería Bécquer (Hospital Universitario de Canarias de Tenerife), Lluís Llauger García, Gerard Corominas LaSalle. (Hospital Universitari de Vic de Barcelona), Carmen Agüera Urbano (Hospital Costa del Sol de Marbella, Málaga), Ester Soy Ferrer (Hospital Josep Trueta de Girona).
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The authors state that they have no conflict of interests with the present work. The ICA-SEMES Research Group has received unrestricted support from Orion Pharma and Novartis. The present study has been designed, performed, analysed, and written exclusively by the authors independently of these pharmaceutical companies.
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The members of the Research Group on Acute Heart Failure of the Spanish Society of Emergency Medicine (ICA-SEMES Research Group) are listed in Acknowledgements.
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Miró, Ò., Gil, V., Martín-Sánchez, F.J. et al. 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. Clin Res Cardiol 107, 698–710 (2018). https://doi.org/10.1007/s00392-018-1237-z
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DOI: https://doi.org/10.1007/s00392-018-1237-z