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Martín-Sánchez FJ, Parra Esquivel P, Llopis García G, González Del Castillo J, Rodríguez Adrada E, Espinosa B, López Díez MP, Romero Pareja R, Rizzi Bordigoni MA, Pérez-Durá MJ, Bibiano C, Ferrer C, Aguiló S, Martín Mojarro E, Aguirre A, Piñera P, López-Picado A, Llorens P, Jacob J, Gil V, Herrero P, Fernández Pérez C, Gil P, Calvo E, Rosselló X, Bueno H, Burillo G, Miró Ò. Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial. Emergencias 2021; 33:165-173. [PMID: 33978329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. MATERIAL AND METHODS Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. RESULTS We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%). CONCLUSION Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Guillermo Llopis García
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Begoña Espinosa
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España
| | - María Pilar López Díez
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Burgos, Burgos, España
| | | | | | | | - Carlos Bibiano
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Vallecas, Madrid, España
| | - Carles Ferrer
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | | | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital Reina Sofía, Murcia, España
| | - Amanda López-Picado
- Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital de Santa Tecla, Tarragona, España
| | - Cristina Fernández Pérez
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Enfermería, Universidad de Enfermería, Madrid, España
| | - Pedro Gil
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Geriatría, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Elpidio Calvo
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), España
| | - Xavier Rosselló
- Servicio de Cardiología, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
| | - Guillermo Burillo
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
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Jacob J, Miró Ò, Ferre C, Borraz-Ordás C, Llopis-García G, Comabella R, Fernández-Cañadas JM, Mercado A, Roset A, Richard-Espiga F, Valero-Domènech A, Martínez-Gimeno JL, Martín-Sánchez FJ, Llorens P, Berrocal-Gil P, Pérez-Durá MJ, Álvarez-Pérez JM, López-Díez P, Herrero-Puente P, Comín-Colet J. Iron deficiency and safety of ferric carboxymaltose in patients with acute heart failure. AHF-ID study. Int J Clin Pract 2020; 74:e13584. [PMID: 32533907 DOI: 10.1111/ijcp.13584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The presence of iron deficiency (ID) in patients with acute heart failure (AHF) is high. There are few studies on the characteristics of these patients and the safety of ferric carboxymaltose administration (FCM). OBJECTIVE Study the differences among patients with AHF based on the presence and type of ID as well as the safety of FCM administration in these patients. METHOD The AHF-ID study is a multicentre, analytical, prospective follow-up cohort including patients admitted to six Spanish hospitals for AHF. ID was defined as serum ferritin <100 μg/L (group A) or ferritin 100-299 μg/L with a TSAT <20% (group B). In cases receiving FCM the appearance of adverse events was analysed. Adjusted Cox regression was used to determine the association with 30-days reattendance for AHF after discharge. RESULTS A total of 221 patients were recruited; 191 (86.4%) presented ID, 121 (63.4%) group A and 70 (36.6%) group B. There were scarce differences between the groups analysed. No differences were found in 30-days reattendance for AHF. FCM was administered to 158 (71.5%) patients, with 8 (5.1%) presenting adverse events, the most frequent being digestive alterations. Treatment was not discontinued in any case. CONCLUSIONS There are scarce differences between the presence and the type of ID in patients with AHF. The administration of FCM in patients with ID and AHF is safe.
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Affiliation(s)
- Javier Jacob
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
- Medical School, University of Barcelona, Spain
| | - Carles Ferre
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Guillermo Llopis-García
- Emergency Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Comabella
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Amparo Mercado
- Emergency Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Alex Roset
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Pablo Berrocal-Gil
- Internal Medicine, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | | | - Pilar López-Díez
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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3
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Miró Ò, Padrosa J, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Montero MM, Tost J, Díez MPL, Traveria L, Torres-Gárate R, Alonso MI, Agüera C, Valero A, Javaloyes P, Peacock WF, Bueno H, Mebazaa A, Fuentes M, Gil C, Alonso H, Garmila P, García GL, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Masó SM, Alonso MI, Ruiz F, Franco JM, Mecina AB, Tost J, Sánchez S, Carbajosa V, Piñera P, Nicolás JAS, Garate RT, Alquezar A, Rizzi MA, Herrera S, Roset A, Cabello I, Richard F, Pérez JMÁ, Diez MPL, Álvarez JV, García BP, Sánchez González MGGYM, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Andueza JA, Romero R, Ruíz M, Calvache R, Lorca MT, Calderón L, Arriaga BA, Sierra B, Mojarro EM, Bécquer LT, Burillo G, García LL, LaSalle GC, Urbano CA, Soto ABG, Padial ED, Ferrer ES, Garrido M, Lucas FJ, Gaya R, Bibiano C, Mir M, Rodríguez B, Sánchez N, Carballo JL, Rodríguez-Adrada E, Rodríguez B. Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study. Eur J Intern Med 2019; 70:24-32. [PMID: 31451322 DOI: 10.1016/j.ejim.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. METHODS Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (<6/6-10/11-15/>15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. RESULTS We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH <6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) >15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. CONCLUSIONS Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy.
| | - Joan Padrosa
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Koji Takagi
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Étienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - María Mir Montero
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Lissete Traveria
- Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Torres-Gárate
- Emergency Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | | | - Carmen Agüera
- Emergency Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Amparo Valero
- Emergency Department, Hospital Doctor Peset, València, Spain
| | - Patricia Javaloyes
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - W Frank Peacock
- The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy; Emergency Department, Baylor College of Medicine, Ben Taub General Hospital, Houston, USA
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy; Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eva Salvo
- Hospital Politénic La Fe de Valencia, Spain
| | - José Pavón
- Hospital Dr. Negrín de Las Palmas de Gran Canaria, Spain
| | - Antonio Noval
- Hospital Insular de Las Palmas de Gran Canaria, Spain
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- Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
| | | | - Sergio Herrera
- Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
| | - Alex Roset
- Hospital Universitari de Bellvitge de Barcelona, Spain
| | - Irene Cabello
- Hospital Universitari de Bellvitge de Barcelona, Spain
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- Hospital Juan XXIII de Tarragona, Spain
| | | | - María Mir
- Hospital Infanta Leonor de Madrid, Spain
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Martín-Sánchez FJ, Cuesta Triana F, Rossello X, Pardo García R, Llopis García G, Caimari F, Vidán MT, Ruiz Artacho P, González Del Castillo J, Llorens P, Herrero P, Jacob J, Gil V, Fernández Pérez C, Gil P, Bueno H, Miró Ò, Matía Martín P, Rodríguez Adrada E, Santos MC, Salgado L, Brizzi BN, Docavo ML, Del Mar Suárez-Cadenas M, Xipell C, Sánchez C, Aguiló S, Gaytan JM, Jerez A, Pérez-Durá MJ, Berrocal Gil P, López-Grima ML, Valero A, Aguirre A, Pedragosa MÀ, Piñera P, LázaroAragues P, Sánchez Nicolás JA, Rizzi MA, Herrera Mateo S, Alquezar A, Roset A, Ferrer C, Llopis F, Álvarez Pérez JM, López Diez MP, Richard F, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Andueza JA, Sevillano Fernández JA, Romero R, Merlo Loranca M, Álvarez Rodríguez V, Lorca MT, Calderón L, Soy Ferrer E, Manuel Garrido J, Martín Mojarro E. Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments. Eur J Intern Med 2019; 65:69-77. [PMID: 31076345 DOI: 10.1016/j.ejim.2019.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Federico Cuesta Triana
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Guillermo Llopis García
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisca Caimari
- Department of Endocrinology, University College London, Hospitals NHS Foundation Trust, London, UK
| | - María Teresa Vidán
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Ruiz Artacho
- Department of Internal Medicine, Clínica Universitaria de Navarra, Madrid, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Emergency Department-UCE-UHD, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Cristina Fernández Pérez
- Universidad Complutense de Madrid, Madrid, Spain; Preventive Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Gil
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Héctor Bueno
- Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Pilar Matía Martín
- Universidad Complutense de Madrid, Madrid, Spain; Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alex Roset
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carles Ferrer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ferrán Llopis
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Rossello X, Miró Ò, Llorens P, Jacob J, Herrero-Puente P, Gil V, Rizzi MA, Pérez-Durá MJ, Espiga FR, Romero R, Sevillano JA, Vidán MT, Bueno H, Pocock SJ, Martín-Sánchez FJ, Fuentes M, Gil C, Alonso H, Garmila P, Rodríguez Adrada E, Llopis García G, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Mínguez Masó S, Isabel Alonso M, Ruiz F, Miguel Franco J, Díaz E, Belén Mecina A, Tost J, Sánchez S, Carbajosa V, Piñera P, Sánchez Nicolás JA, Torres Garate R, Alquezar A, Alberto Rizzi M, Herrera S, Roset A, Cabello I, Richard F, Álvarez Pérez JM, Pilar López Diez M, Vázquez Álvarez J, Alonso Morilla A, Irimia A, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Antonio Andueza J, Antonio Sevillano J, Romero R, Calvache R, Lorca MT, Calderón L, Amores Arriaga B, Sierra B, Martín Mojarro E, Travería Bécquer L, Burillo G, Llauger García L, Corominas LaSalle G, Agüera Urbano C, Belén García A, Elisa Delgado Padial S, Soy Ferrer E, Garrido M, Javier Lucas F, Gaya R. Effect of Barthel Index on the Risk of Thirty-Day Mortality in Patients With Acute Heart Failure Attending the Emergency Department: A Cohort Study of Nine Thousand Ninety-Eight Patients From the Epidemiology of Acute Heart Failure in Emergency Departments Registry. Ann Emerg Med 2019; 73:589-598. [DOI: 10.1016/j.annemergmed.2018.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 11/09/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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7
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Romero R, Gaytán JM, Aguirre A, Llorens P, Gil V, Herrero P, Jacob J, Martín-Sánchez FJ, Pérez-Durá MJ, Alquézar A, López ML, Roset À, Peacock WF, Hollander JE, Coll-Vinent B, Miró Ò. The role of atrial fibrillation in the short-term outcomes of patients with acute heart failure. Clin Res Cardiol 2018; 108:622-633. [PMID: 30426240 DOI: 10.1007/s00392-018-1389-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/22/2018] [Indexed: 01/10/2023]
Abstract
AIMS To investigate whether the presence of atrial fibrillation (AF) is independently associated with adverse short-term outcomes in patients diagnosed with acute heart failure (AHF) in the emergency department (ED). METHODS We performed a secondary analysis of patients included in the EAHFE registries 4&5. Patients were divided by the presence of sinus rhythm (SR) or AF at ED arrival. The primary outcome was 30-day all-cause mortality. Secondary outcomes included the 30-day post-discharge combined endpoint of ED revisit or hospitalisation due to AHF and all-cause mortality. We recorded 54 independent variables that can affect outcomes. Cox regression was used to investigate adjusted significant associations between AF and outcomes. Analyses were repeated according to whether AF was previously known and whether AF was considered responsible for the AHF episode. RESULTS We analysed 6045 ED visits (mean age 80.4 years, 55.9% women), 3644 (60.3%) with AF. The cumulative 30-day mortality was 9.4%, and the adverse combined endpoint (ACE) was 25.9% (ED revisit with and without hospitalisation were 16.5 and 8.9% and death occurred in 4.7%). No differences were found in outcomes of AHF patients with SR and AF, and among the latter group, no differences were found depending on whether AF was considered responsible for the AHF episode. Patients with previously known AF had significantly lower 30-day mortality and higher post-discharge ACE rates, although these differences disappeared after adjustment for confounders HR 0.782, 95% CI 0.590-1.037, p = 0.087; and HR 1.131, 95% CI 0.924-1.385, p = 0.234). CONCLUSION The coexistence of AF does not impact the short-term outcomes of patients diagnosed with AHF in the ED.
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Affiliation(s)
- Rodolfo Romero
- Emergency Department, Hospital Universitario de Getafe, School of Biomedical and Health Sciences, Universidad Europea, Madrid, Spain
| | - Josep María Gaytán
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Medical School, University Miguel Hernández, Elx, Alicante, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Àlex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - W Frank Peacock
- Emergency Department, Baylor College of Medicine, Houston, TX, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Blanca Coll-Vinent
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Medical School, University of Barcelona, Barcelona, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. .,Medical School, University of Barcelona, Barcelona, Spain.
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Carbajosa Dalmau J, Cosín-Sales J, Pérez-Durá MJ, Noceda J, Urtubia-Palacios A, Hernández-Sori N, Peiró-Gómez A, Jacob J, Llorens P, Ruescas-Gómez L, Martín-Martínez A. [Vernakalant in hospital emergency practice: safety and effectiveness]. Emergencias 2018; 29:397-402. [PMID: 29188914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study the effectiveness and safety of vernakalant for restoration of sinus rhythm in patients with atrial fibrillation (AF) in routine hospital emergency department care, and to evaluate factors associated with a more effective response. MATERIAL AND METHODS Prospective multicenter cohort study enrolling consecutive patients who were administered vernakalant for medical cardioversion of AF between September 2014 through March 2016 in 5 hospitals in the Spanish autonomous community of Valencia. RESULTS We studied 165 cases. The median (interquartile range) was 68 years (56-77) years. Cardioversion with vernakalant was effective in 77.6% (95% CI, 71.1%-84%). The median time to conversion was 8 ( 6-12) minutes after a first dose and 34 (22-62) minutes after a second dose. A prior history of cardiac insufficiency was nonsignificantly less common in patients who converted with vernakalant (6.3%) than in those who did not (18.9%) (adjusted odds ratio [OR], 0.45 [95% CI, 0.13-1.56]; P=.208). Having no prior history of AF was nonsignificantly related to greater effectiveness (in 54.7% vs in 35.1% with prior AF). Duration less than 12 hours was significantly associated with greater effectiveness (83.6% vs 59.5%; adjusted OR, 2.76 [95% CI, 1.12-6.80]; P=.028). Adverse events were reported for 30 patients. None of the events had clinically important consequences, and in only 2 cases (1.2%) was it necessary to suspend treatment. CONCLUSION Vernakalant is effective and safe for restoring sinus rhythm in the hospital emergency department.
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Affiliation(s)
- José Carbajosa Dalmau
- Servicio Urgencias,Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España. Grupo de Arritmias Cardiacas, SEMES
| | - Juan Cosín-Sales
- Servicio Cardiología, Hospital Arnau de Villanova, Valencia, España
| | | | - José Noceda
- Servicio Urgencias, Hospital de Sagunto, Valencia, España
| | | | - Néstor Hernández-Sori
- Servicio Urgencias,Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España. Grupo de Arritmias Cardiacas, SEMES
| | - Ana Peiró-Gómez
- Servicio Urgencias, Hospital Arnau de Villanova, Valencia, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | | | - Alfonso Martín-Martínez
- Grupo de Arritmias Cardiacas, SEMES. Servicio Urgencias, Hospital Universitario Severo Ochoa, Madrid, España
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Llopis García G, González del Castillo J, Rizzi MA, Alquezar A, Piñera P, Lázaro Aragues P, Llorens P, Herrero P, Jacob J, Gil V, Fernández C, Bueno H, Miró Ò, Pérez-Durá MJ, Gil PB, Miró Ó, Espinosa VG, Sánchez C, Aguiló S, Vall MÀP, Aguirre A, Piñera P, Aragues PL, Bordigoni MAR, Alquezar A, Richard F, Jacob J, Ferrer C, Llopis F, Sánchez FJM, del Castillo JG, Rodríguez-Adrada E, García GL, Salgado L, Mandly EA, Ortega JS, de los Ángeles Cuadrado Cenzual M, de Heredia MDIO, Soriano PL, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Puente PH, García IR, Coya MF, Fernández JAS, Andueza J, Pareja RR, del Arco C, Martín A, Torres R, Miranda BR, Martín VS, Guillén CB, Puig RP. Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure. Am J Cardiol 2017; 120:1151-1157. [PMID: 28826899 DOI: 10.1016/j.amjcard.2017.06.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 12/16/2022]
Abstract
The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.
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11
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Carbajosa V, Martín-Sánchez FJ, Llorens P, Herrero P, Jacob J, Alquézar A, Pérez-Durá MJ, Alonso H, Garrido JM, Torres-Murillo J, López-Grima MI, Piñera P, Fernández C, Miró Ò. [Factors associated with short stays for patients admitted with acute heart failure]. Emergencias 2016; 28:366-374. [PMID: 29106080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify factors associated with short hospital stays for patients admitted with acute heart failure (AHF) admitted to hospitals with short-stay units (SSU). MATERIAL AND METHODS Multicenter nonintervention study in a multipurpose cohort of patients with AHF to 10 Spanish hospitals with short-stay units; patients were followed prospectively. We recorded demographic data, medical histories, baseline cardiorespiratory and function variables on arrival in the emergency department, on admission, and at 30 days. The outcome variable was a short hospital stay (<= 4 days). We built receiver operating characteristic curves of simple and mixed predictive models for short stays and calculated the area under the curves. RESULTS A total of 1359 patients with a mean (SD) age of 78.7 (9.9) years (53.9% women) were included; 568 (41.8%) had short stays. Five hundred ninety patients (43.4%) were admitted to SSU and 769 (56.6%) were admitted to conventional wards. The variables associated with a short-stay according to the mixed regression model were hypertensive crisis (odds ratio [OR], 1.79; 95% CI, 1.17-2.73; P=.007) and admission to a SSU (OR, 16.6; 95% CI, 10.0-33.3; P<.001). Hypotensive AHF (OR, 0.49; 95% CI, 0.26-0.91; P=.025), hypoxemia (OR, 0.68; 95% CI, 0.53-0.88; P=.004); and admission on a Wednesday, Thursday, or Friday (OR, 0.62; 95% CI, 0.49-0.77; P<.001) were associated with a long stay. The area under the receiver operating characteristic curve was 0.827 (95% CI, 0.80-0.85; P<.001). Thirty-day mortality and readmission rates did not differ between patients with short vs long stays (mortality, 0.5% in both cases, P=.959; and readmission, 22.9% vs 27.7%, respectively; P=.059). CONCLUSION Both clinical and administrative factors are independently related to whether patients with AHF have short stays in the hospitals studied, and among therapy, it is remaslcasle the existence of a SSU.
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Affiliation(s)
- Virginia Carbajosa
- Servicio de Urgencias, Hospital Universitario Río Hortega, Valladolid, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General Universitario de Alicante. Alicante, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Aitor Alquézar
- Servicio de Urgencias, Hospital Sant Pau, Barcelona, España
| | | | - Héctor Alonso
- Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | | | | | | | - Pascual Piñera
- Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Cristina Fernández
- Servicio de Urgencias, Hospital Sant Pau, Barcelona, España. Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, España. Grupo de investigación "Urgencias: procesos y patologías", IDIBAPS. Barcelona, España
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12
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Llorens P, Escoda R, Miró Ò, Herrero-Puente P, Martín-Sánchez FJ, Jacob J, Garrido JM, Pérez-Durá MJ, Gil C, Fuentes M, Alonso H, Muller C, Mebazaa A. [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. [PMID: 29077328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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. CONCLUSION 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.
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Affiliation(s)
- Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital Universitario General de Alicante, Alicante, España
| | - Rosa Escoda
- Servicio de Urgencias, Hospital Clinic de Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clinic de Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, España
| | - Pablo Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Grupo de Investigación de Urgencias-HUCA, Oviedo, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, España
| | | | | | - Cristina Gil
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España
| | - Marta Fuentes
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España
| | - Héctor Alonso
- Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | - Christian Muller
- Cardiology Department, University Hospital of Basel, Basel, Suiza
| | - Alexander Mebazaa
- Department of Anaesthesia and Intensive Care, INSERM UMR 942, Lariboisière Hospital, University of Paris - Diderot, Paris, Francia
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Herrero-Puente P, Marino-Genicio R, Martín-Sánchez FJ, Vázquez-Alvarez J, Jacob J, Bermudez M, Llorens P, Miró O, Pérez-Durá MJ, Gil V, Alonso-Morilla A. Characteristics of acute heart failure in very elderly patients - EVE study (EAHFE very elderly). Eur J Intern Med 2014; 25:463-70. [PMID: 24837751 DOI: 10.1016/j.ejim.2014.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 04/01/2014] [Accepted: 04/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the characteristics and prognostic factors of early death in the very elderly with acute heart failure (AHF). PATIENTS AND METHODS We performed a prospective, observational study of AHF patients attended in Emergency Departments (ED), analyzing 45 variables collected in ED and studying troponin, natriuretic peptides and echocardiographies, not always available in the ED. The patients were divided into 2 groups: nonagenarian (age ≥ 90 years) and controls (age < 90 years). The study variables were mortality and death or reconsultation to the ED for AHF within 30 days after inclusion. RESULTS We included 4700 patients (nonagenarians: 520, 11.1%). The 30-day mortality was 21.5% and 8.7% (p<0.01), respectively with a combined event of 33.3% and 26.7% (p=0.001). Age ≥ 90 years was maintained in all the models associated with death (OR: 1.94, CI 95%: 1.40-2.70). In nonagenarians, chronic kidney insufficiency (OR: 2.07, CI95%: 1.16-3.69), severe functional dependence (OR: 2.18, CI95%; 1.30-3.64) and basal oxygen saturation <90% (OR: 1.97, CI95%: 1.17-3.32) and hyponatremia <135 mEq/L (OR: 1.89, CI95%: 1.05-3.42) were predictive variables of mortality. We observed an association between elevated troponin levels and natriuretic peptide values > 5,180 pg/mL and mortality (OR: 4.26, CI95%: 1.83-9.89; and OR: 3.51, CI95%: 1.45-8.48; respectively). CONCLUSIONS The profile of nonagenarians with AHF differs from that of younger patients. Although very advanced age is an independent prognostic factor of mortality, these patients have fewer predictive factors of mortality, being only functional deterioration, basal kidney disease, hyponatremia and respiratory insufficiency on arrival at the ED and probably troponin values and elevated natriuretic peptides.
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Affiliation(s)
- Pablo Herrero-Puente
- Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain.
| | - Rocio Marino-Genicio
- Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain
| | | | - Joaquín Vázquez-Alvarez
- Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain
| | - Javier Jacob
- Department of Emergency Medicine, Hospital Universitaride Bellvitge, Barcelona, Spain
| | - Manuel Bermudez
- Department of Management of Geriatric Care, Hospital Monte Naranco, Oviedo, Spain
| | - Pere Llorens
- Department of Emergency Medicine-Short-Stay Unit and Home Hospitalization, Hospital Universitario General de Alicante, Alicante, Spain
| | - Oscar Miró
- Department of Emergency Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - Victor Gil
- Department of Emergency Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Ana Alonso-Morilla
- Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain
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Llorens P, Miró Ò, Herrero P, Martín-Sánchez FJ, Jacob J, Valero A, Alonso H, Pérez-Durá MJ, Noval A, Gil-Román JJ, Zapater P, Llanos L, Gil V, Perelló R. Clinical effects and safety of different strategies for administering intravenous diuretics in acutely decompensated heart failure: a randomised clinical trial. Emerg Med J 2013; 31:706-13. [PMID: 23793945 DOI: 10.1136/emermed-2013-202526] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The mainstay of treatment for acutely decompensated heart failure (ADHF) is intravenous diuretic therapy either as a bolus or via continuous infusion. OBJECTIVES We evaluated the clinical effects and safety of three strategies of intravenous furosemide administration used in emergency departments (EDs) for ADHF. METHODS We performed a multicentre, randomised, parallel-group study. Patients with ADHF were randomised within 2 h of ED arrival to receive furosemide by continuous infusion (10 mg/h, group 1) or boluses (20 mg/6 h, group 2; or 20 mg/8 h, group 3). The primary end point was total diuresis, and secondary end points were dyspnoea, orthopnoea, extension of rales and peripheral oedema, blood pressure, respiratory and heart rates, and pulse oximetry, which were measured at arrival and 3, 6, 12 and 24 h after treatment onset. We also measured serum creatinine, sodium and potassium levels at arrival and after 24 h. RESULTS Group 1 patients (n=36) showed greater 24 h diuresis (3705 mL) than those in groups 2 (n=37) and 3 (n=36) (3093 and 2670 mL, respectively; p<0.01), and this greater diuretic effect was observed earlier. However, no differences were observed among groups in the nine secondary clinical end points evaluated. Creatinine deterioration developed in 15.6% of patients, hyponatraemia in 9.2%, and hypokalaemia in 19.3%, with the only difference among groups observed in hypokalaemia (group 1, 36.3%; group 2, 13.5%; group 3, 8.3%; p<0.01). CONCLUSIONS In patients with ADHF attending the ED, boluses of furosemide have a smaller diuretic effect but provide similar clinical relief, similar preservation of renal function, and a lower incidence of hypokalaemia than continuous infusion. TRIAL REGISTRATION NUMBER This randomised trial was registered in the European Clinical Trial Database (EudraCT) with the reference number 2008-004488-20.
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Affiliation(s)
- Pere Llorens
- Emergency Department and Short-Stay Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic de Barcelona; 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, Barcelona, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Amparo Valero
- Emergency Department, Hospital Dr Peset, Valencia, Spain
| | - Héctor Alonso
- Emergency Department, Hospital Marques de Valdecilla, Santander, Spain
| | | | - Antonio Noval
- Emergency Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - José Juan Gil-Román
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pedro Zapater
- Clinical Pharmacology Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Lucía Llanos
- Clinical Pharmacology Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clinic de Barcelona; 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, Barcelona, Spain
| | - Rafel Perelló
- Emergency Department, Hospital Clinic de Barcelona; 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, Barcelona, Spain
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Herrero-Puente P, Martín-Sánchez FJ, Fernández-Fernández M, Jacob J, Llorens P, Miró Ò, Alvarez AB, Pérez-Durá MJ, Alonso H, Garrido M. Differential clinical characteristics and outcome predictors of acute heart failure in elderly patients. Int J Cardiol 2011; 155:81-6. [PMID: 21397963 DOI: 10.1016/j.ijcard.2011.02.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/10/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We determined the clinical-epidemiological characteristics and prognostic factors of early mortality and re-consultation in an elderly population attending the hospital emergency department (HED) for acute heart failure (AHF). PATIENTS AND METHODS A prospective, observational, non interventional study including all the patients with AHF attended in the Spanish's HED. Two groups were defined: elderly (≥ 80 years) and controls (< 80 years). VARIABLES demographic characteristics, comorbidity, degree of cardiac involvement, previous treatment, symptoms and signs of the AHF episode, precipitating factors, treatment in the HED and outcome. OUTCOME VARIABLES mortality and re-consultation within 30 days. RESULTS Of the 942 patients included, 455 of whom were elderly (48.3%). In this elderly population female sex, auricular fibrillation and a history of ictus and a poor functional status predominated. The type of ventricular dysfunction was unknown in 70%. No main differences in the presentation of AHF were found between the two groups. Mortality and re-consultation to the HED within 30 days were similar in both groups. While several factors were identified to be related to mortality or re-consultation in control group, in the elderly group it was more difficult to identify patients who will die or re-consult to the HED within the following 30 days. Only respiratory insufficiency on arrival to the HED was found to predict a greater probability of death (OR 3.55; CI95% 1.39-9.11). CONCLUSIONS AHF in elderly patients presents some differential characteristics and, most importantly, it is more difficult to identify which of these patients will die or re-consult in the short-term.
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Affiliation(s)
- Pablo Herrero-Puente
- Area of Emergency Medicine, Hospital Universitario Central de Asturias, Emergency Medicine Investigation Group-HUCA, Oviedo, Spain.
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