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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

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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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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).

Author information

Authors and Affiliations

  1. Emergency Department, Hospital Clínic, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain

    Òscar Miró, V.íctor Gil, Sira Aguiló & Gemma Martínez

  2. Medical School, University of Barcelona, Barcelona, Catalonia, Spain

    Òscar Miró

  3. Emergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Madrid, Spain

    Francisco Javier Martín-Sánchez

  4. Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain

    Javier Jacob

  5. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Herrero

  6. Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain

    Aitor Alquézar

  7. Emergency Department, Hospital Universitari de Vic, Barcelona, Catalonia, Spain

    Lluís Llauger

  8. Laboratory of Biostatistics and Epidemiology, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain

    José Ríos

  9. Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Catalonia, Spain

    José Ríos

  10. Cardiology Department, Hospital Universitario de Canarias and Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Santa Cruz de Tenerife, Spain

    Alberto Domínguez-Rodríguez

  11. Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland

    Veli-Pekka Harjola

  12. Cardiology Department, Hospital University of Basel, Basel, Switzerland

    Christian Müller

  13. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece

    John Parissis

  14. Emergency Department, Baylor College of Medicine, Houston, TX, USA

    W. Frank Peacock

  15. Home Hospitalization and Short Stay Unit, Emergency Department, Hospital General de Alicante, Alicante, Spain

    Pere Llorens

  16. Medical School, Miguel Hernandez University, Elche, Alicante, Spain

    Pere Llorens

Authors
  1. Òscar Miró
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  2. V.íctor Gil
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  3. Francisco Javier Martín-Sánchez
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  4. Javier Jacob
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Consortia

The Research Group on Acute Heart Failure of the Spanish Society of Emergency Medicine (ICA-SEMES Research Group) Researchers

  • Marta Fuentes
  • , Cristina Gil
  • , María José Pérez-Durá
  • , Eva Salvo
  • , Carolina Xipell
  • , Carolina Sánchez
  • , Josep M. Gaytan
  • , Antonio Noval
  • , José M. Torres
  • , Maria Luisa López-Grima
  • , Amparo Valero
  • , Alfons Aguirre
  • , Maria Àngels Pedragosa
  • , Raquel Torres-Gárate
  • , María Isabel Alonso
  • , Francisco Ruiz
  • , José Miguel Franco
  • , Susana Sánchez
  • , Aitor Alquézar
  • , Miguel Alberto Rizzi
  • , Sergio Herrera
  • , Fernando Richard
  • , Francisco Javier Lucas
  • , Irene Cabello
  • , Álex Roset
  • , José Manuel Garrido
  • , Héctor Alonso
  • , Esther Rodríguez Adrada
  • , Guillermo Llopis García
  • , Fernando Richard
  • , José María Álvarez Pérez
  • , María Pilar López Diez
  • , Ana Belén Mecina
  • , Javier Lucas
  • , Joaquín Vázquez Álvarez
  • , Marta Sánchez González
  • , Belén Prieto
  • , María García García
  • , Víctor Marquina
  • , Inmaculada Jiménez
  • , Patricia Javaloyes
  • , Néstor Hernández
  • , Benjamin Brouzet
  • , Ana López
  • , Juan Antonio Andueza
  • , Rodolfo Romero
  • , Roberto Calvache
  • , María Teresa Lorca
  • , Luis Calderón
  • , Beatriz Amores Arriaga
  • , Beatriz Sierra
  • , Pascual Piñera
  • , José Andrés Sñanchez Nicolás
  • , Enrique Martín Mojarro
  • , Lisette Travería Bécquer
  • , Lluís Llauger García
  • , Gerard Corominas LaSalle
  • , Carmen Agüera Urbano
  •  & Ester Soy Ferrer

Corresponding author

Correspondence to Òscar Miró.

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Conflict of interest

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.

Additional information

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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