Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study
Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs).
We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups.
We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115–2.811; p = 0.016), and 1.939 (95% CI 1.114–3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance.
Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
KeywordsAcute heart failure Outcome Mortality Prehospital care Advanced life support
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 (PI10/01918, PI11/01021, PI15/01019 and PI15/00773) and 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).
Other investigators of the ICA-SEMES research group: Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca), Héctor Alonso, Pablo Garmila (Hospital Marqués de Valdecilla), Esther Rodríguez Adrada (Hospital Clínico San Carlos, Madrid), Rosa Escoda, Carolina Xipell, Carolina Sánchez, Josep Mª Gaytan (Hospital Clínic de Barcelona), Eva Salvo, María José Pérez-Durá (Hospital La Fe de Valencia), Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria), José M. Torres (Hospital Reina Sofía de Córdoba), María Ángeles Juan-Gómez, María Luisa López-Grima, Amparo Valero (Hospital Dr. Peset de Valencia), Alfons Aguirre, Maria Àngels Pedragosa (Hospital del Mar de Barcelona), Maria Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla), José Miguel Franco (Hospital Miguel Servet de Zaragoza), Elena Diaz (Hospital San Juan de Alicante), Ana Belén Mecina (Hospital de Alcorcón), Josep Tost (Consorci Sanitari de Terrassa), Susana Sánchez (Hospital Rio Ortega de Valladolid), Pascual Piñera (Hospital Reina Sofía de Murcia), Raquel Torres-Garate (Hospital Severo Ochoa), Aitor Alquezar, Miguel Alberto Rizzi, Sergio Herrera (Hospital de la Santa Creu y Sant Pau de Barcelona), Irene Cabello (Hospital Universitari de Bellvitge, Barcelona), José María Álvarez-Pérez, Maria Pilar López-Diez. (Hospital Universitario de Burgos), Joaquin Vázquez-Alvarez, Marta Sánchez-González, Jose Juan Gil-Román (Hospital Universitario Central de Asturias), José Manuel Carratalá, Benjamin Brouzet, Víctor Marquina, Inmaculada Jiménez, Néstor Hernández, Francisco Román (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), Maria Teresa Lorca, Luis Calderón (Hospital delTajo de Madrid), Beatriz Amores Arriaga, Beatriz Sierra (Hospital Clínico Lozano Blesa de Zaragoza), 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 JosepTrueta de Girona).
Compliance with ethical standards
Conflict of interest
The authors state that they have no conflict of interests with the present study. The ICA-SEMES Research Group has received unrestricted support from Orion Pharma and Novartis. The present study was designed, performed, analysed and written exclusively by the authors independently of these pharmaceutical companies.
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