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Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure

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Abstract

Objectives

To analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007–2016).

Methods

The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries.

Results

Compared to other large registries, our patients were older [80 (10) years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6) days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period.

Conclusions

The EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.

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Acknowledgements

We thank Alicia Diaz for invaluable assistance in the administration and maintenance of the database. ICA-SEMES Research Group: Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca), Pablo Garmila (Hospital Marqués de Valdecilla de Santander), Esther Rodríguez Adrada, Guillermo Llopis García, Luis Escobar, María Matesanz, Javier Perdigones (Hospital Clínico San Carlos, Madrid), Rosa Escoda, Carolina Xipell, Carolina Sánchez, Josep Mª Gaytan (Hospital Clínic de Barcelona), María José Pérez-Durá (Hospital La Fe de Valencia), José Pavón, Ana Bella Álvarez (Hospital Dr. Negrín de Las Palmas de Gran Canaria), Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria), José M. Torres (Hospital Reina Sofía de Córdoba), María Luisa López-Grima, Amparo Valero, Marian Ángeles Juan (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, Virginia Carbajosa (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, María Pilar López Diez. (Hospital Universitario de Burgos), Joaquín Vázquez Álvarez, Ana Alonso Morilla, Andrea Irimia (Hospital Universitario Central de Asturias), Víctor Marquina, Benjamín Brouzet, Inmaculada Jiménez, Néstor Hernández, Sergio Ramos, Ana López, Francisco Román, Verónica González (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 del Tajo 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 Garcia, 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), and Alex Roset (Hospital de Bellvitge, Barcelona).

Funding

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, PI15/00773, PI15/01019, and PI11/01021) and Fundació la Marató de TV3 (2015). The Research Group “ED: processes and pathologies”, IDIBAPS, receives funding from the Government of Catalonia for consolidated research groups (GRC 2009–2013 and 2014–2016). The AHF-SEMES group has received unconditional support from Orion Pharma, Otsuka, and Novartis.

Author information

Authors and Affiliations

  1. Emergency Department, Short Stay Unit and Hospitalization at Home, ISABIAL-Fundación FISABIO, Hospital Universitario General de Alicante, Alicante, Spain

    Pere Llorens & Patricia Javaloyes

  2. Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitario Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Madrid, Spain

    Francisco Javier Martín-Sánchez

  3. The GREAT (Global REsearch on Acute conditions Team) Network, Rome, Italy

    Francisco Javier Martín-Sánchez & Òscar Miró

  4. Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain

    Javier Jacob

  5. Emergency Department, Grupo de Investigación de Urgencias-HUCA, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Herrero-Puente

  6. “Emergencies: Processes and Pathologies” Research Group, Emergency Department, IDIBAPS, Hospital Clínic, Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain

    Víctor Gil & Òscar Miró

  7. Emergency Department, Hospital Virgen de la Macarena, Seville, Spain

    José Manuel Garrido

  8. Emergency Department, Hospital Politécnico La Fe, Valencia, Spain

    Eva Salvo

  9. Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain

    Marta Fuentes

  10. Emergency Department, Hospital Marqués de Valdecilla, Santander, Spain

    Héctor Alonso

  11. Emergency Department, Hospital Universitario de Burgos, Burgos, Spain

    Fernando Richard

  12. Emergency Department, Hospital General de Albacete, Albacete, Spain

    Francisco Javier Lucas

  13. Cardiology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain

    Héctor Bueno

  14. National Centre for Cardiovascular Research (CNIC), Madrid, Spain

    Héctor Bueno

  15. Second Department of Cardiology, University of Athens Medical School, Athens, Greece

    John Parissis

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

    Christian E. Müller

  17. School of Medicine, University of Barcelona, Barcelona, Spain

    Òscar Miró

Authors
  1. Pere Llorens
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  2. Patricia Javaloyes
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  3. Francisco Javier Martín-Sánchez
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  4. Javier Jacob
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  5. Pablo Herrero-Puente
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  6. Víctor Gil
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  7. José Manuel Garrido
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  8. Eva Salvo
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  9. Marta Fuentes
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  10. Héctor Alonso
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  11. Fernando Richard
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  12. Francisco Javier Lucas
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  13. Héctor Bueno
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  15. Christian E. Müller
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  16. Òscar Miró
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Consortia

the ICA-SEMES Research Group

  • Marta Fuentes
  • , Cristina Gil
  • , Pablo Garmila
  • , Esther Rodríguez Adrada
  • , Guillermo Llopis García
  • , Luis Escobar
  • , María Matesanz
  • , Javier Perdigones
  • , Rosa Escoda
  • , Carolina Xipell
  • , Carolina Sánchez
  • , Josep Mª Gaytan
  • , María José Pérez-Durá
  • , José Pavón
  • , Ana Bella Álvarez
  • , Antonio Noval
  • , José M. Torres
  • , María Luisa López-Grima
  • , Amparo Valero
  • , Marian Ángeles Juan
  • , Alfons Aguirre
  • , Maria Àngels Pedragosa
  • , Maria Isabel Alonso
  • , Francisco Ruiz
  • , José Miguel Franco
  • , Elena Diaz
  • , Ana Belén Mecina
  • , Josep Tost
  • , Susana Sánchez
  • , Virginia Carbajosa
  • , Pascual Piñera
  • , Raquel Torres Garate
  • , Aitor Alquezar
  • , Miguel Alberto Rizzi
  • , Sergio Herrera
  • , Irene Cabello
  • , José María Álvarez Pérez
  • , María Pilar López Diez
  • , Joaquín Vázquez Álvarez
  • , Ana Alonso Morilla
  • , Andrea Irimia
  • , Víctor Marquina
  • , Benjamín Brouzet
  • , Inmaculada Jiménez
  • , Néstor Hernández
  • , Sergio Ramos
  • , Ana López
  • , Francisco Román
  • , Verónica González
  • , 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
  •  & Alex Roset

Corresponding author

Correspondence to Òscar Miró.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

The complete list of the ICA-SEMES Research Group (Research group on Acute Heart Failure of the Spanish Society of Emergency Medicine) members is listed in the Acknowledgements section.

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Llorens, P., Javaloyes, P., Martín-Sánchez, F.J. et al. Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure. Clin Res Cardiol 107, 897–913 (2018). https://doi.org/10.1007/s00392-018-1261-z

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  • DOI: https://doi.org/10.1007/s00392-018-1261-z

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