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Short-term outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care

Session Acute heart failure: how to improve survival

Speaker Oscar Miro

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Clinical
  • Session type : Rapid Fire Abstracts

Authors : O Miro (Barcelona,ES), V Gil (Barcelona,ES), FJ Martin-Sanchez (Madrid,ES), J Jacob (Barcelona,ES), P Herrero-Puente (Oviedo,ES), S Aguilo (Barcelona,ES), R Escoda (Barcelona,ES), A Dominguez-Rodriguez (Santa Cruz de Tenerife,ES), J Marco-Hernandez (Barcelona,ES), G Martinez (Barcelona,ES), V Rico (Barcelona,ES), C Sanchez (Barcelona,ES), J Parissis (Athens,GR), CE Muller (Basel,CH), P Llorens (Barcelona,ES)

Authors:
O Miro1 , V Gil1 , FJ Martin-Sanchez2 , J Jacob3 , P Herrero-Puente4 , S Aguilo1 , R Escoda1 , A Dominguez-Rodriguez5 , J Marco-Hernandez1 , G Martinez1 , V Rico1 , C Sanchez1 , J Parissis6 , CE Muller7 , P Llorens1 , 1Hospital Clinic de Barcelona, Emergency Department - Barcelona - Spain , 2Hospital Clinic San Carlos, Emergency Department - Madrid - Spain , 3University Hospital of Bellvitge, Emergency Department - Barcelona - Spain , 4University Hospital Central de Asturias, Emergency Department - Oviedo - Spain , 5University Hospital of the Canaries, Cardiology Department - Santa Cruz de Tenerife - Spain , 6Attikon University Hospital, Cardiology Department - Athens - Greece , 7University Hospital Basel, Cardiology Department - Basel - Switzerland ,

On behalf: ICA-SEMES Research Group

Topic(s):
Acute Heart Failure - Clinical

Aims:To compare short-term outcomes after an episode of acute heart failure (AHF) in patients with a reduced and preserved ejection fraction (HFrEF, <40%; and HFpEF, >49%; respectively) according to their destinations after emergency department (ED) care.

Methods and Results:This secondary analysis of the EAHFE Registry (consecutive AHF patients diagnosed in 41 Spanish EDs) investigated 30-day all-cause mortality, in-hospital all-cause mortality, prolonged hospitalisation (>7 days), and 30-day post-discharge ED revisit due to AHF, all-cause death, and combined endpoint (ED revisit/death) in 5,829 patients with echocardiographically documented HFrEF and HfpEF (HFrEF/HFpEF: 1,442/4,387). Adjusted ratios were calculated for patients admitted to internal medicine (IM), short stay unit (SSU), and discharged from the ED without hospitalisation (DEDWH) compared with those admitted to cardiology. For HFrEF, the only significant differences were lower in-hospital mortality (OR=0.26; 95%CI=0.08-0.81; p=0.021) and prolonged hospitalisation (OR=0.07; 95%CI=0.04-0.13; p<0.001) related to SSU admission. For HFpEF, IM admission had a higher post-discharge 30-day mortality (HR=1.85; 95%CI=1.05-3.25; p=0.033) and combined endpoint (HR=1.24; 95%CI=1.01-1.64; p=0.044); SSU admission had a lower in-hospital mortality (OR=0.43; 95%CI=0.23-0.80; p=0.008) and prolonged hospitalisation (OR=0.17; 95%CI=0.13-0.23; p<0.001) but a higher post-discharge 30-day combined endpoint (HR=1.29; 95%CI=1.01-1.64; p=0.041); and DEDDWH had a lower 30-day mortality (HR=0.46; 95%CI=0.28-0.75; p=0.002) but higher post-discharge ED revisit (HR=1.62; 95%CI=1.31-2.00; p<0.001) (Figure 1)

Conclusion:While HFrEF patients have similar short-term outcomes irrespective of the destination after ED care for an AHF episode, HFpEF patients experience worse short-term outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.

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