Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
Por:
Diez, M, Llorens, P, Martin-Sanchez, F, Gil, V, Jacob, J, Herrero, P, Llauger, L, Tost, J, Aguirre, A, Garrido, J, Vega, J, Fuentes, M, Alonso, M, Grima, M, Pinera, P, Romero, R, Lucas-Imbernon, F, Andueza, J, Povar, J, Richard, F, Sanchez, C and Miro, O
Publicada:
1 oct 2022
Categoría:
Emergency medicine
Resumen:
Objectives. To analyze whether short-term outcomes are affected when patients diagnosed with acute heart failure (AHF) spend time in an emergency department observation unit (EDOU) before hospital admission.
Methods. Baseline and emergency episode data were collected for patients diagnosed with AHF in the EDs of 15 Spanish hospitals. We analyzed crude and adjusted associations between EDOU stay and 30-day mortality (primary outcome) and in-hospital mortality and a prolonged hospital stay of more than 7 days (secondary outcomes).
Results. A total of 6597 patients with a median (interquartile range) age of 83 (76-88 years) were studied. Fifty-five percent were women. All were hospitalized for AHF (50% in internal medicine wards, 23% in cardiology, 11% in geriatrics, and 16 in other specialties. Of these patients, 3241 (49%) had had EDOU stays and 3350 (51%) had been admitted immediately, with no EDOU stay. Having an EDOU stay was associated with female sex, dementia or chronic obstructive pulmonary disease, long-term treatment with certain drugs for heart failure, greater baseline deterioration in function, and a higher degree of decompensation. Patients in the EDOU group were more often admitted to an intemal medicine ward and had shorter stays; cardiology, geriatric, and intensive care admissions were less likely to have had an EDOU stay. Overall, 30-day mortality was 12.6% (13.7% in the EDOU group and 11.4% in the no-EDOU group; P= .004). In-hospital mortality was 10.4% overall (EDOU, 11.1% and no-EDOU, 9.6%; P=.044). Prolonged hospitalization occurred in 50.0% (EDOU, 48.7% and no-EDOU, 51.2%; P = .046). After adjusting for between-group differences, the EDOU stay was not associated with 30-day mortality (hazard ratio, 1.14; 95% CI, 0.99-1.31). Odds ratios for associations between EDOU stay and in-hospital mortality and prolonged hospital stay, respectively, were 1.09 (95% CI, 0.92-1.29) and 0.91 (95% CI, 0.82-1.01).
Conclusion. Although mortality higher in patients hospitalized for AHF who spend time in an EDO, the association seems to be accounted for by their worse baseline situation and the greater seriousness of the decompensation episode, not by time spent in the EDOU.
Filiaciones:
Diez, M:
Hosp Univ Burgos, Serv Urgencias, Burgos, Spain
Llorens, P:
Univ Miguel Hernandez, Serv Urgencias Corta Estancia & Hospitalizac Domi, Hosp Gen Alicante, Inst Invest Sanitaria & Bidmed Alicante ISABIAL, Alicante, Spain
Martin-Sanchez, F:
Univ Complutense, Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain
Gil, V:
Univ Barcelona, Hosp Clin, IDIBAPS, Area Urgencias, Barcelona, Spain
Jacob, J:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Herrero, P:
Hosp Univ Cent Asturias, Serv Urgencias, Oviedo, Spain
Llauger, L:
Hosp Univ Vic, Serv Urgencias, Barcelona, Spain
Tost, J:
Consorci Hosp Terrassa, Serv Urgencias, Barcelona, Spain
Aguirre, A:
Hosp Mar, Serv Urgencias, Barcelona, Spain
Garrido, J:
Hosp Virgen Macarena, Serv Urgencias, Seville, Spain
Vega, J:
Hosp Univ Reina Sofia, Serv Urgencias, Cordoba, Spain
Fuentes, M:
Hosp Univ Salamanca, Serv Urgencias, Salamanca, Spain
Alonso, M:
Hosp Valme, Serv Urgencias, Seville, Spain
:
Hosp Dr Peset, Serv Urgencias, Valencia, Spain
Pinera, P:
Hosp Univ Reina Sofia, Serv Urgencias, Murcia, Spain
Romero, R:
Univ Europea, Hosp Univ Getafe, Serv Urgencias, Madrid, Spain
Lucas-Imbernon, F:
Hosp Univ Albacete, Serv Urgencias, Albacete, Spain
Andueza, J:
Hosp Univ Dr Gregorio Maranon, Serv Urgencias, Madrid, Spain
Povar, J:
Hosp Univ Miguel Servet, Serv Urgencias, Zaragoza, Spain
Richard, F:
Hosp Univ Burgos, Serv Urgencias, Burgos, Spain
Sanchez, C:
Hosp Univ Burgos, Serv Urgencias, Burgos, Spain
Miro, O:
Univ Barcelona, Hosp Clin, IDIBAPS, Area Urgencias, Barcelona, Spain
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