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Time trends in characteristics, clinical course and outcomes of an unselected sample of 13,791 Spanish patients with acute heart failure (2007-2016)

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), P Javaloyes (Alicante,ES), V Gil (Barcelona,ES), P Herrero-Puente (Oviedo,ES), FJ Martin-Sanchez (Madrid,ES), H Bueno (Madrid,ES), J Parissis (Athens,GR), CE Muller (Basel,CH), MP Lopez-Diez (Burgos,ES), JM Garrido (Seville,ES), E Salvo (Valencia,ES), M Fuentes (Salamanca,ES), F Richard (Burgos,ES), FJ Lucas (Albacete,ES), P Llorens (Alicante,ES)

O Miro1 , P Javaloyes2 , V Gil1 , P Herrero-Puente3 , FJ Martin-Sanchez4 , H Bueno5 , J Parissis6 , CE Muller7 , MP Lopez-Diez8 , JM Garrido9 , E Salvo10 , M Fuentes11 , F Richard8 , FJ Lucas12 , P Llorens2 , 1Hospital Clinic de Barcelona, Emergency Department - Barcelona - Spain , 2General University Hospital of Alicante, Emergency Department - Alicante - Spain , 3University Hospital Central de Asturias, Emergency Department - Oviedo - Spain , 4Hospital Clinic San Carlos, Emergency Department - Madrid - Spain , 5National Centre for Cardiovascular Research (CNIC) - Madrid - Spain , 6Attikon University Hospital, Cardiology Department - Athens - Greece , 7University Hospital Basel, Cardiology Department - Basel - Switzerland , 8University Hospital of Burgos, Emergency Department - Burgos - Spain , 9University Hospital of Virgen Macarena, Emergency Department - Seville - Spain , 10Hospital Universitario y Politécnico La Fe, Emergency Department - Valencia - Spain , 11Hospital Clínico Universitario, Emergency Department - Salamanca - Spain , 12Albacete University Hospital, Emergency Department - Albacete - Spain ,

On behalf: ICA-SEMES Research Group

Acute Heart Failure - Clinical

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

Patients and Methods. The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at 5 different time points (2007/2009/2011/2014/2016). Eighty fundamental variables and patient outcomes were described and  statistically significant changes along time were evaluated.  We also compared our data with large ED- and hospital-based registries.

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

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

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