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Miró Ò, Takagi K, Davison BA, Edwards C, Freund Y, Jacob J, Llorens P, Mebazaa A, Cotter G. Effect of systemic corticosteroid therapy for acute heart failure patients with elevated C-reactive protein. ESC Heart Fail 2022; 9:2225-2232. [PMID: 35393762 PMCID: PMC9288737 DOI: 10.1002/ehf2.13926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS The current study explores whether degree of inflammation, reflected by C-reactive protein (CRP) level, modifies the effect of intravenous (IV) corticosteroid administered in the emergency department (ED) on clinical outcomes in patients with acute heart failure (AHF). METHODS AND RESULTS We selected patients diagnosed with AHF in the ED, with confirmed N-terminal pro-B-type natriuretic peptide > 300 pg/mL and CRP > 5 mg/L in the ED from the Epidemiology of Acute Heart Failure in the Emergency Departments (EAHFE) registry. In these 1109 patients, 121 were treated by corticosteroid. The corticosteroid therapy hazard ratio (HR) for 30 day all-cause mortality was 1.26 [95% confidence interval (CI) 0.75-2.09, P = 0.38]. Although not statistically significant, HRs tended to decrease with increasing CRP level, with point estimates favouring corticosteroid at CRP levels above 20. In patients with CRP > 40 mg/L, with adjusted HRs of 0.56 (95% CI 0.20-1.55, P = 0.27) for 30 day all-cause mortality, 0.92 (95% CI 0.52-1.62, P = 0.78) for 30 day post-discharge ED revisit, hospitalization, or death, and adjusted odds ratio of 0.61 (95% CI 0.17-2.14, P = 0.44) for in-hospital all-cause mortality. CONCLUSIONS The present analysis suggests that corticosteroids might have the potential to improve outcomes in AHF patients with inflammatory activation. Larger, prospective studies of anti-inflammatory therapy should be considered to assess potential benefit in patients with the highest degree of inflammation.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain.,University of Barcelona, Barcelona, Catalonia, Spain
| | - Koji Takagi
- Momentum Research, Inc, Chapel Hill, NC, USA
| | - Beth A Davison
- Momentum Research, Inc, Chapel Hill, NC, USA.,Inserm U942 MASCOT, Paris, France
| | | | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux 18 de Paris (APHP), Sorbonne Université, Paris, France
| | - Javier Jacob
- University of Barcelona, Barcelona, Catalonia, Spain.,Emergency Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home, Hospital General de Alicante, Alicante, Spain.,Miguel Hernández University, Alicante, Spain
| | - Alexandre Mebazaa
- Inserm U942 MASCOT, Paris, France.,Department of Anesthesiology and Critical Care and Burn Unit, Hôpital Saint-Louis Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Gad Cotter
- Momentum Research, Inc, Chapel Hill, NC, USA.,Inserm U942 MASCOT, Paris, France
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Verdu-Rotellar JM, Abellana R, Vaillant-Roussel H, Gril Jevsek L, Assenova R, Kasuba Lazic D, Torsza P, Glynn LG, Lingner H, Demurtas J, Thulesius H, Muñoz MA. Risk stratification in heart failure decompensation in the community: HEFESTOS score. ESC Heart Fail 2021; 9:606-613. [PMID: 34811953 PMCID: PMC8787964 DOI: 10.1002/ehf2.13707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/01/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings. Methods and results HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the derivation cohort and 58.8% in the validation one (P = 0.004). Mortality/hospitalization during the first 30 days after a decompensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles (OR: 2.35; P = 0.01), New York Heart Association functional class III/IV (OR: 2.11; P = 0.001), oxygen saturation ≤ 90% (OR: 4.98; P < 0.001), heart rate > 100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45; P < 0.001). The model showed an area under the curve (AUC) of 0.807, 95% confidence interval (CI): [0.770; 0.845] in the derivation cohort and AUC 0.73, 95% CI: [0.660; 0.808] in the validation one. No significant differences between both cohorts were observed (P = 0.08). Regarding probability of hospitalization/death, three risk groups were defined: low <5%, medium 5–20%, and high >20%. Outcome incidence was 2.7% for the low‐risk group, 12.8% for medium risk, and 46.2% for high risk in the derivation cohort, and 9.1%, 12.9%, and 39.6% in the validation one. Conclusions The HEFESTOS score, based on variables easily accessible in a community setting and validated in an external European cohort, properly predicted the risk of death/hospitalization during the first 30 days after an HF decompensation episode.
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Affiliation(s)
- José-María Verdu-Rotellar
- Gerencia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa Abellana
- Departament de Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Helene Vaillant-Roussel
- Faculty of Medicine, UPU ACCePPT, Department of General Practice, CHU, Direction de La Recherche Clinique et de l'Innovation, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Radost Assenova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Djurdjica Kasuba Lazic
- Department of Family Medicine "Andrija Stampar" School of Public Health, School of Medicine University of Zagreb, Zagreb, Croatia
| | | | - Liam George Glynn
- Health Research Institute and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Heidrun Lingner
- Hannover Medical School-Center for Public Health and Healthcare, Hannover, Germany
| | - Jacopo Demurtas
- Primary Care Department, Azienda Usl Toscana Sud Est, Grosseto, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Medicine and Optometry, Linnaeus University, Växjö, Sweden
| | - Miguel Angel Muñoz
- Gerencia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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3
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Miró Ò, Rossello X, Platz E, Masip J, Gualandro DM, Peacock WF, Price S, Cullen L, DiSomma S, de Oliveira MT, McMurray JJ, Martín-Sánchez FJ, Maisel AS, Vrints C, Cowie MR, Bueno H, Mebazaa A, Mueller C. Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 9:375-398. [PMID: 33191763 DOI: 10.1177/2048872620930889] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients. METHODS AND RESULTS A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4-13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74-0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80-0.84. CONCLUSIONS There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.
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Affiliation(s)
- Òscar Miró
- Emergency Department, University of Barcelona, Spain
| | - Xavier Rossello
- Cardiology Department, Hospital Universitari Son Espases, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Grupo de Fisiopatologia y Terapeutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - Josep Masip
- Intensive Care Department, University of Barcelona, Spain.,Cardiology Department, Hospital Sanitas CIMA, Spain
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.,Heart Institute (INCOR), University of Sao Paulo Medical School, Brazil
| | - W Frank Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, USA
| | - Susanna Price
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia
| | - Salvatore DiSomma
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | | | - John Jv McMurray
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia
| | - Francisco J Martín-Sánchez
- Department of Emergency Medicine, Hospital Clínico San Carlos, Spain.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, USA
| | | | - Martin R Cowie
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Department of Cardiology and Cardiovascular Research Area, Universidad Complutense de Madrid, Spain
| | - Alexandre Mebazaa
- University Paris Diderot, France.,APHP Hôpitaux Universitaires Saint Louis Lariboisière, France
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
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4
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Arranz M, Jacob J, Sancho-Ramoneda M, Lopez À, Navarro-Sáez MC, Cousiño-Chao JR, López-Altimiras X, López I Vengut F, García-Trallero O, German A, Farré-Cerdà J, Zorrilla J. Characteristics and Prognosis of Patients Who Receive Noninvasive Ventilation and Present Limitation of Life Support Treatment: The LLST-NIVCat Multicenter Cohort Study. J Emerg Med 2020; 59:477-484. [PMID: 32684380 DOI: 10.1016/j.jemermed.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/16/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patients who receive noninvasive ventilation (NIV) in the emergency department (ED) sometimes have a limitation of life support treatment (LLST). The characteristics and prognosis in these patients may be worse, however, few studies have been carried out in this respect. OBJECTIVE Analyze the differences between patients receiving NIV in the ED with LLST (NIV-LLST) or without LLST (NIV-noLLST) and their impact on in-hospital mortality, as well as investigate in-hospital mortality in the NIV-LLST group. METHOD We performed a secondary analysis of data from the NIVCat registry. This was a prospective, multicenter, analytical cohort study with consecutive inclusion of patients receiving NIV from February to March 2015 in 11 hospital EDs in Spain. Data on the baseline characteristics, the acute episode, and final patient destination were collected. The dependent variable was all-cause in-hospital mortality. RESULTS We analyzed 152 cases receiving NIV, 66 (43.4%) of whom had NIV-LLTS. Age ≥ 75 years was associated with NIV-LLST. In-hospital mortality was higher in the NIV-LLST group, with an adjusted hazard ratio of 2.50 (95% confidence interval [CI] 1.03-6.06). Patients with NIV-LLST presenting an exacerbation of chronic obstructive pulmonary disease (COPD) presented the lowest mortality, with an odds ratio of 0.27 (95% confidence interval 0.08-0.93), compared with the remaining patients. CONCLUSION In our cohort of patients receiving NIV in the ED, the presence of LLST is frequent and is associated with high hospital mortality. The NIV-LLST patients with a COPD exacerbation have a better prognosis than NIV-LLST patients with other diseases.
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Affiliation(s)
- María Arranz
- Emergency Department, Hospital de Viladecans, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Àngels Lopez
- Sistema d'Emergències Mèdiques, Barcelona, Spain
| | | | | | | | - Francesc López I Vengut
- Emergency Department, Parc sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Antonio German
- Emergency Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Jaume Farré-Cerdà
- Emergency Department, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
| | - José Zorrilla
- Emergency Department, Xarxa Assistencial de Manresa, Fundació Althaia, Barcelona, Spain
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5
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Accurate predictions in the emergency department will lead to improvements in patient outcomes: about the urgency to apply this concept to patients with dyspnoea and acute heart failure. Eur J Emerg Med 2019; 26:390-391. [PMID: 31688216 DOI: 10.1097/mej.0000000000000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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6
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García Garmendia JL, Fernández Sosbilla JM, Gallego Lara SL. Morphine Use in Acute Heart Failure and Limitation of Therapeutic Effort. Chest 2019. [PMID: 29519305 DOI: 10.1016/j.chest.2017.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Jose Luis García Garmendia
- Hospital San Juan de Dios del Aljarafe Ringgold standard institution, Critical Care and Emergency Department, Bormujos, Sevilla, Spain.
| | - José Manuel Fernández Sosbilla
- Hospital San Juan de Dios del Aljarafe Ringgold standard institution, Critical Care and Emergency Department, Bormujos, Sevilla, Spain
| | - Sonia Luisa Gallego Lara
- Hospital San Juan de Dios del Aljarafe Ringgold standard institution, Critical Care and Emergency Department, Bormujos, Sevilla, Spain
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7
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Roset A, Jacob J, Herrero-Puente P, Alquézar A, Martín-Sanchez FJ, Llorens P, Llauger L, Gil V, Miró Ò. Characteristics and prognosis of patients with acute heart failure without troponin determination: The EAHFE-TROPICA3 study. Arch Cardiovasc Dis 2019; 112:390-399. [PMID: 31014989 DOI: 10.1016/j.acvd.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/08/2019] [Accepted: 02/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The absence of cardiac troponin (cTn) determination in an episode of acute heart failure (AHF) is frequent. The characteristics of these patients are not well known; nor is it known whether they have a better prognosis than patients in whom cTn is determined. AIM The objective of the EAHFE-TROPICA3 study was to analyse the characteristics of patients consulting for AHF in whom cTn was not determined (nocTn), and to evaluate the relationship of cTn determination (wcTn) with patient outcomes. METHODS This was an analysis of the multipurpose prospective EAHFE registry of patients with AHF consulting at the emergency departments of 34 Spanish hospitals. RESULTS Data from 8850 patients with AHF were analysed; cTn was not determined in 4216 of these patients (47.6%), who had a lower prevalence of ischaemic heart disease, more frequent use of loop diuretics at baseline, a greater rate of oedema in the acute episode, more frequent history of heart failure, and less use of angiotensin-converting enzyme inhibitors or aldosterone receptor antagonists and beta-blockers at baseline. Compared with the wcTn group, the nocTn group had the same in-hospital mortality (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 0.98-1.50), mortality at 30 days (adjusted OR 1.07, 95% CI 0.90-1.28) and reconsultation at 30 days (adjusted OR 0.90, 95% CI 0.80-1.02). CONCLUSIONS Patients presenting with AHF with and without cTn determination have different characteristics. These differences are not related to a better prognosis.
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Affiliation(s)
- Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Catalonia, Spain.
| | - Pablo Herrero-Puente
- Emergency Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Catalonia, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital At-Home, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Lluís Llauger
- Department of Emergency Medicine, Hospital Universitari de Vic, 08500 Barcelona, Catalonia, Spain
| | - Victor Gil
- Emergency Department, Hospital Clínic, Research Group "Emergencies: Processes and Pathologies", IDIBAPS, 08036 Barcelona, Catalonia, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Research Group "Emergencies: Processes and Pathologies", IDIBAPS, 08036 Barcelona, Catalonia, Spain
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8
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Miró Ò, Rosselló X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero P, Jacob J, López-Grima ML, Gil C, Lucas Imbernón FJ, Garrido JM, Pérez-Durá MJ, López-Díez MP, Richard F, Bueno H, Pocock SJ. Utilidad de la escala MEESSI para la estratificación del riesgo de pacientes con insuficiencia cardiaca aguda en servicios de urgencias. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.04.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Identification of Senior At Risk scale predicts 30-day mortality among older patients with acute heart failure. Med Intensiva 2018; 44:9-17. [PMID: 30166245 DOI: 10.1016/j.medin.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 06/30/2018] [Accepted: 07/07/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the value of frailty screening tool (Identification of Senior at Risk [ISAR]) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart failure (AHF). DESIGN Observational multicenter cohort study. SETTING OAK-3 register. SUBJECTS Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016. INTERVENTION No. VARIABLES Variable of study was ISAR scale. The outcome was all-cause 30-day mortality. RESULTS We included 1059 patients (mean age 85±5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value <.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655-0.751; P<.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0-1 points). CONCLUSIONS scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality.
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10
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Interpretación de resultados estadísticos. Med Intensiva 2018; 42:370-379. [DOI: 10.1016/j.medin.2017.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/18/2017] [Accepted: 12/25/2017] [Indexed: 12/30/2022]
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11
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Miró Ò, Rosselló X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero P, Jacob J, López-Grima ML, Gil C, Lucas Imbernón FJ, Garrido JM, Pérez-Durá MJ, López-Díez MP, Richard F, Bueno H, Pocock SJ. The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department. ACTA ACUST UNITED AC 2018; 72:198-207. [PMID: 29903688 DOI: 10.1016/j.rec.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/25/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. METHODS We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium- or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. RESULTS We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. CONCLUSIONS The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients.
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Affiliation(s)
- Òscar Miró
- Servicio de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
| | - Xavier Rosselló
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Víctor Gil
- Servicio de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Cristina Gil
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | - Fernando Richard
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Zaninović Jurjević T, Dvornik Š, Kovačić S, Matana Kaštelan Z, Brumini G, Matana A, Zaputović L. A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure. Acta Clin Belg 2018; 74:102-109. [DOI: 10.1080/17843286.2018.1483562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Štefica Dvornik
- Department for Laboratory Diagnostics, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Slavica Kovačić
- Department for Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Gordana Brumini
- Faculty of Health Studies, Department for Basic Medical Sciences University of Rijeka, Rijeka, Croatia
| | - Ante Matana
- Department for Cardiovascular Diseases, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Luka Zaputović
- Department for Cardiovascular Diseases, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review. Nutrients 2018; 10:nu10010058. [PMID: 29320401 PMCID: PMC5793286 DOI: 10.3390/nu10010058] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/10/2017] [Accepted: 01/02/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. Methods: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. Results: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. Conclusions: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.
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Non-invasive ventilation in emergency departments in public hospitals in Catalonia. The VENUR-CAT study. Med Intensiva 2017. [PMID: 28625339 DOI: 10.1016/j.medin.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To know the implementation and characteristics of non-invasive ventilation (NIV) in the Emergency Departments (EDs) of public hospitals in Catalonia (Spain) and analyze possible differences based on the typology, degree of activity and the availability of an Intensive Care Unit (ICU) in the hospital. DESIGN A non-interventional, descriptive study was carried out, using a structured questionnaire divided into 3sections: 1) professional experience and training; 2) devices used; and 3) clinical scenarios and the use of NIV. SETTING Persons responsible for public EDs in Catalonia. RESULTS Fifty-two of the 54 public EDs in Catalonia responded (96.3%). Fifty-one perform NIV, which is mainly initiated by emergency care physicians (78.5%); 66.7% maintain the patient in the ED until discharge; and in 43.1% of the cases the length of stay is>24h. Of the EDs, 39.2% have their own protocol, 35.3% of which are established by consensus with other departments (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.014]), while 25.5% have no protocol, and 43.1% register the activity. Training represents the greatest difficulty for the implementation of NIV, but 19.6% do not provide specific training. When support is needed, the main physician of reference is the intensivist (35.3%) (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.002]). CONCLUSIONS In most EDs in Catalonia, NIV is performed by emergency care physicians. Areas needing improvement include drainage of patients once NIV has been started, the promotion of protocols, registry of activity, and training of the healthcare professionals.
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Jacob J, Roset A, Miró Ò, Alquézar A, Herrero P, Martín-Sanchez FJ, Möckel M, Müller C, Llorens P. EAHFE – TROPICA2 study. Prognostic value of troponin in patients with acute heart failure treated in Spanish hospital emergency departments. Biomarkers 2017; 22:337-344. [DOI: 10.1080/1354750x.2016.1265006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Research Group “Emergencies: processes and diseases”, IDIBAPS, Barcelona, Catalonia, Spain
| | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Martin Möckel
- Department of Cardiology Division of Emergency Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Christian Müller
- Department of Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital at-home, Hospital General Universitario de Alicante, Alicante, Spain
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Réplica a «Comentarios sobre el estudio SOPICA en España». Rev Clin Esp 2017; 217:59-60. [DOI: 10.1016/j.rce.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
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Jacob J, Tost J, Miró Ò, Herrero P, Martín-Sánchez FJ, Llorens P. Impact of chronic obstructive pulmonary disease on clinical course after an episode of acute heart failure. EAHFE-COPD study. Int J Cardiol 2016; 227:450-456. [PMID: 27838130 DOI: 10.1016/j.ijcard.2016.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study if the coexistence of chronic obstructive pulmonary disease (COPD) in patients diagnosed with acute heart failure (AHF) at the emergency department (ED) has an impact on short- and long-term outcomes. METHOD The EAHFE-COPD study included patients who attended in 34 Spanish EDs for AHF. We compared patients with AHF plus COPD with patients with AHF in whom COPD was neither diagnosed nor excluded by functional respiratory tests (FRT). Outcome analysis included all-cause mortality, prolonged hospitalization, and ED revisit. Crude results were adjusted by differences between patients with and without COPD. RESULTS We included 8099 patients with AHF, 2069 having COPD (25.6%; AHF-COPD-known). Compared with AHF-COPD-unknown, AHF-COPD-known differed in 20 variables. After adjusting for differences between the two groups, AHF-COPD-known patients showed no significant differences in 30-day mortality (OR=0.89; 95% CI=0.71-1.11), prolonged hospitalization in general wards (OR=1.04; 95% CI=0.89-1.22) or SSU (OR=1.38; 95% CI=0.97-1.97), and 1-year mortality (HR: 1.02; 95% CI=0.89-1.17), but showed a higher 30-day revisit rate (OR=1.32; 95% CI=1.13-1.54). CONCLUSIONS In patients attending the ED for AHF, the coexistence of COPD is only associated with an increased risk of short-term ED revisit, but not prolonged hospitalization and short- or long-term mortality.
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Affiliation(s)
- Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Tost
- Servicio de Urgencias, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, Spain; Grupo de investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pere Llorens
- Servicio de Urgencias-UCE y UHD, Hospital General Universitario de Alicante, Alicante, Spain
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