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Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study

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Abstract

Objective

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).

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al (2014) The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 63:1123–1133

    Article  PubMed  Google Scholar 

  2. Sporer KA, Tabas JA, Tam RK, Sellers KL, Rosenson J, Barton CW et al (2006) Do medications affect vital signs in the prehospital treatment of acute decompensated heart failure? Prehosp Emerg Care 10:41–45

    Article  PubMed  Google Scholar 

  3. Peacock WF (2016) When and for how long do patients with acute heat failure have to be admitted? Emergencias 28:363–365

    PubMed  Google Scholar 

  4. Harjola P, Tolonen J, Boyd J, Mattila J, Koski R, Palomäki A et al (2017) The role of pre-hospital management in acute heart failure. Eur J Heart Fail 19:287–289

    Article  PubMed  Google Scholar 

  5. Miró O, Llorens P, Escalada X, Herrero P, Jacob J, Gil V et al (2017) Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure). Emergencias 29:223–230

    PubMed  Google Scholar 

  6. 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

    Google Scholar 

  7. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (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

    Article  Google Scholar 

  8. Packer M, O’Connor C, McMurray JJV, Wittes J, Abraham WT, Anker SD et al (2017) Effect of ularitide on cardiovascular mortality in acute heart failure. N Engl J Med 376:1956–1964

    Article  CAS  PubMed  Google Scholar 

  9. Novartis Media Relations (2017) Novartis provides update on phase III study of RLX030 (serelaxin) in patients with acute heart failure. https://www.novartis.com/news/media-releases/novartis-provides-update-phase-iii-study-rlx030-serelaxin-patients-acute-heart. Accessed 14 Apr

  10. Martín-Sánchez FJ, Christ M, Miró Ò, Peacock WF, McMurray JJ, Bueno H et al (2016) Practical approach on frail older patients attended for acute heart failure. Int J Cardiol 222:62–71

    Article  PubMed  PubMed Central  Google Scholar 

  11. Miró O, Rosselló X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero-Puente P et al (2017) Predicting 30-day mortality for patients with acute heart failure who are in the emergency department: a cohort study. Ann Intern Med. https://doi.org/10.7326/M16-2726 (press)

    Google Scholar 

  12. Matsue Y, Ter Maaten JM, Suzuki M, Torii S, Yamaguchi S, Fukamizu S et al (2017) Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction. Clin Res Cardiol. https://doi.org/10.1007/s00392-017-1122-1 (press)

    PubMed  PubMed Central  Google Scholar 

  13. Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S et al (2015) Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail 17:544–558

    Google Scholar 

  14. Harjola P, Harjola VP (2017) Can we do more for patients with acute heart failure before arrival at the hospital? Emergencias 29:221–222

    PubMed  Google Scholar 

  15. 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

    Article  Google Scholar 

  16. Miró Ò, Gil V, Xipell C, Sánchez C, Aguiló S, Martín-Sánchez FJ et al (2017) IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards. Clin Res Cardiol 106:369–378

    Article  PubMed  Google Scholar 

  17. Legrand M, Ludes PO, Massy Z, Rossignol P, Parenica J, Park JJ et al (2017) Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications. Clin Res Cardiol. https://doi.org/10.1007/s00392-017-1173-3 (Epub ahead of print)

    PubMed  Google Scholar 

  18. Li KH, Raghunathan TE, Rubin DB (1991) Large-sample significance levels from multiply imputed data using moment-based statistics and an F reference distribution. J Am Stat Assoc 86:1065–1073

    Google Scholar 

  19. Hoffman JR, Reynolds S (1987) Comparison of nitroglycerin, morphine and furosemide in treatment of presumed pre-hospital pulmonary edema. Chest 92:586–593

    Article  CAS  PubMed  Google Scholar 

  20. Jaronik J, Mikkelson P, Fales W, Overton DT (2006) Evaluation of prehospital use of furosemide in patients with respiratory distress. Prehosp Emerg Care 10:194–197

    Article  PubMed  Google Scholar 

  21. Peacock WF, Costanzo MR, De Marco T, Lopatin M, Wynne J, Mills RM et al (2009) Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE Registry. Cardiology 113:12–19

    Article  PubMed  Google Scholar 

  22. Bertini G, Giglioli C, Biggeri A, Margheri M, Simonetti I, Sica ML et al (1997) Intravenous nitrates in the prehospital management of acute pulmonary edema. Ann Emerg Med 30:493–499

    Article  CAS  PubMed  Google Scholar 

  23. Gardtman M, Waagstein L, Karlsson T, Herlitz J (2000) Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcome? Eur J Emerg Med 7:15–24

    Article  CAS  PubMed  Google Scholar 

  24. Wakai A, McCabe A, Kidney R, Brooks SC, Seupaul RA, Dierks DB et al (2013) Nitrates for acute heart failure syndromes. Cochrane Database Syst Rev 8:CD005151

    Google Scholar 

  25. Herrero-Puente P, Jacob J, Martín-Sánchez FJ, Vázquez-Álvarez J, Martínez-Camblor P, Miró Ò et al (2015) Influence of intravenous nitrate treatment on early mortality among patients with acute heart failure. NITRO-EAHFE study. Rev Esp Cardiol 68:959–967

    Article  Google Scholar 

  26. Vital FM, Ladeira MT, Atallah AN (2013) Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 5:CD005351

    Google Scholar 

  27. Williams TA, Finn J, Perkins GD, Jacobs IG (2013) Prehospital continuous positive airway pressure for acute respiratory failure: a systematic review and meta-analysis. Prehosp Emerg Care 17:261–273

    Article  PubMed  Google Scholar 

  28. Bakke SA, Botker MT, Riddervold IS, Kirkegaard H, Christensen EF (2014) Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure: a systematic review of controlled studies. Scand J Trauma Resusc Emerg Med 22:69

    Article  PubMed  PubMed Central  Google Scholar 

  29. Goodacre S, Stevens JW, Pandor A, Poku E, Ren S, Cantrell A et al (2014) Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis. Acad Emerg Med 21:960–970

    Article  PubMed  Google Scholar 

  30. Miró Ò, Gil V, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Mebazaa A et al (2017) Morphine use in the ED and outcomes of patients with acute heart failure: a propensity score-matching analysis based on the EAHFE Registry. Chest 152:821–832

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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 (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).

Author information

Author notes

  1. Òscar Miró and Melissa Hazlitt have equally contributed to the manuscript and should both be considered as first authors.

Authors and Affiliations

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

    Òscar Miró, Víctor Gil & Verónica Rico

  2. “Emergencies: processes and pathologies” Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain

    Òscar Miró, Víctor Gil & Verónica Rico

  3. http://www.greatnetwork.org/int/

    Òscar Miró, Michael Christ, Salvatore di Somma, Said Laribi, Alexandre Mebazaa & Veli-Pekka Harjola

  4. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA

    Melissa Hazlitt & David C. Cone

  5. Emergency Medical Services, Barcelona, Spain

    Xavier Escalada

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

    Pere Llorens

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

    Francisco Javier Martín-Sánchez

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

    Pia Harjola & Veli-Pekka Harjola

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

    Pablo Herrero-Puente

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

    Javier Jacob

  11. Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany

    Martin Möckel

  12. Department of Emergency and Critical Care Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany

    Michael Christ

  13. Emergency Department, Hôpital Pitie-Salpêtrière, Sorbonne University, Paris, France

    Yonathan Freund

  14. Department of Medical-Surgery Sciences and Translational Medicine Emergency Department Sant’Andrea Hospital, University of Rome La Sapienza, Rome, Italy

    Salvatore di Somma

  15. Emergency Medicine Department, School of Medicine and Tours University Hospital, François-Rabelais University, 37044, Tours, France

    Said Laribi

  16. Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France

    Alexandre Mebazaa

Authors
  1. Òscar Miró
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  2. Melissa Hazlitt
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  3. Xavier Escalada
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  4. Pere Llorens
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  5. Víctor Gil
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  6. Francisco Javier Martín-Sánchez
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  7. Pia Harjola
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  8. Verónica Rico
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  9. Pablo Herrero-Puente
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  10. Javier Jacob
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  11. David C. Cone
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  12. Martin Möckel
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  13. Michael Christ
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  14. Yonathan Freund
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  15. Salvatore di Somma
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  16. Said Laribi
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  18. Veli-Pekka Harjola
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Consortia

On behalf of the ICA-SEMES Research Group

  • Marta Fuentes
  • , Cristina Gil
  • , Héctor Alonso
  • , Pablo Garmila
  • , Esther Rodríguez Adrada
  • , Rosa Escoda
  • , Carolina Xipell
  • , Carolina Sánchez
  • , Josep Mª Gaytan
  • , Eva Salvo
  • , María José Pérez-Durá
  • , Antonio Noval
  • , José M. Torres
  • , Maria Ángeles Juan-Gómez
  • , María Luisa López-Grima
  • , Amparo Valero
  • , Alfons Aguirre
  • , Maria Àngels Pedragosa
  • , Maria Isabel Alonso
  • , Francisco Ruiz
  • , José Miguel Franco
  • , Elena Diaz
  • , Ana Belén Mecina
  • , Josep Tost
  • , Susana Sánchez
  • , Pascual Piñera
  • , Raquel Torres-Garate
  • , Aitor Alquezar
  • , Miguel Alberto Rizzi
  • , Sergio Herrera
  • , Irene Cabello
  • , José María Álvarez-Pérez
  • , Maria Pilar López-Diez
  • , Joaquin Vázquez-Alvarez
  • , Marta Sánchez-Gonzalez
  • , Jose Juan Gil-Román
  • , José Manuel Carratalá
  • , Benjamin Brouzet
  • , Víctor Marquina
  • , Inmaculada Jiménez
  • , Néstor Hernández
  • , Francisco Román
  • , Juan Antonio Andueza
  • , Rodolfo Romero
  • , Roberto Calvache
  • , Maria Teresa Lorca
  • , Luis Calderón
  • , Beatriz Amores Arriaga
  • , Beatriz Sierra
  • , Enrique Martín-Mojarro
  • , Lisette Travería-Bécquer
  • , Lluís Llauger-Garcia
  • , 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 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.

Additional information

The ICA-SEMES Research Group members are listed in Acknowledgements.

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Miró, Ò., Hazlitt, M., Escalada, X. et al. Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study. Clin Res Cardiol 107, 347–361 (2018). https://doi.org/10.1007/s00392-017-1190-2

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  • DOI: https://doi.org/10.1007/s00392-017-1190-2

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