Characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: based on the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments)
Llorens P, Escoda R, Miró O, Herrero Puente P, Martín-Sánchez FJ, Jacob J, Garrido JM, Pérez-Durá MJ, Gil C, Fuentes M, Alonso H, Muller C, Mebazaa A
Affiliation of the authors
Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital Universitario General de Alicante, Alicante, Spain. Servicio de Urgencias, Hospital Clinic de Barcelona, Grupo de Investigación Urgencias: procesos y patologías, IDIBAPS, Barcelona, Spain. Servicio de Urgencias, Hospital Universitario Central de Asturias, Grupo de Investigación de Urgencias-HUCA, Oviedo, Spain. Servicio de Urgencias y Unidad de Corta Estancia, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, Spain. Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, Spain. Servicio de Urgencias, Hospital Politécnico La Fe, Valencia, Spain. Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, Spain. Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain. Cardiology Department, University Hospital of Basel, Basel, Swizerland. Department of Anaesthesia and Intensive Care, INSERM UMR 942, Lariboisière Hospital, University of Paris – Diderot, Paris, France.
Llorens P, Escoda R, Miró O, Herrero Puente P, Martín-Sánchez FJ, Jacob J, et al. Characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: based on the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). Emergencias. 2015;27:11-22
Summary
Objectives.
To analyze data recorded in the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments), which collects information on the clinical characteristics and laboratory findings of patients with acute heart failure (AHF) treated in 29 Spanish hospital emergency departments (EDs) as well as therapies used and clinical course. We analyzed changes in management observed over time and compared the results with data recorded in
other AHF registries.
Material and methods. Prospective multicenter cohort study of consecutive patients treated in 3 different years: 2007, 2009, and 2011. We collected demographic, clinical, and laboratory data; medications taken prior to the emergency and in the ED; and outcome variables (in-hospital and 30-day and 1-year mortality rates, readmissions within 30 days). Changes in therapy and course in the 3 years were analyzed. The literature was reviewed to find other national and international AHF registries.
Results.
A total of 5845 patients were included (2007, 948; 2009, 1483; 2011, 3414). The mean age was 79 years and 56% were women. The AHF episode registered was the first experienced by 34.6% of the patients. Comorbidity was high: 82% had hypertension, 42.3% had diabetes mellitus, and 47.7% had atrial fibrillation. Severe or total functional dependence was observed in 21.9%, and 57.3% had systolic dysfunction (left ventricular ejection fraction, 38.3%). The main treatments administered consisted in diuretics (96.8%), endovenous nitroglycerine (20.7%), noninvasive ventilation (6.4%), and inotropic agents or vasopressors (3.6%). The glomerular filtration rate was low in 57%. Troponin and natriuretic peptide levels were measured in the EDs in 49.1% and 42.4% of the cases, respectively. Patients presented as normotensive in 66.4% of the cases, hypertensive in 23.5%, and hypotensive in 4.6% (0.7% in shock); 76.1% were admitted (1.9% to the ICU). The median hospital stay was 7 days and 23.9% were discharged from the ED. In-hospital mortality was 7.6%; 30-day mortality was 9.4% and 1-year mortality 29.5%. Orders for troponin and natriuretic peptide determinations increased over the 3 study periods, and the intravenous infusion of diuretics and inotropic agents and vasoconstrictors decreased (P < 0.001, all comparisons). Revisits within 30 days also decreased (P = 0.004). No changes were observed in in-hospital or 30-day mortality rates between 2007 and 2011.
We reviewed 14 previously published registry reports (8 compiled prospectively); only 2 of the registries included ED patients.
Conclusions.
The EAHFE registry describes the characteristics of AHF in a cohort that resembles the universe of our patients with AHF. Significant changes were observed over time in some aspects of AHF management. Revisits decreased, but mortality rates remained unchanged. Only 2 other previously analyzed registries included patients with AHF treated in hospital EDs.
