Comparative Analysis of Short-Term Outcomes of Patients With Heart Failure With a Mid-Range Ejection Fraction After Acute Decompensation
Por:
Miró Ò, Javaloyes P, Gil V, Martín-Sánchez FJ, Jacob J, Herrero P, Marco-Hernández J, Ríos J, Harjola VP, Torres-Gárate R, Alonso MI, Piñera P, Mecina AB, Escoda R, Müller C, Parissis J, Llorens P and ICA-SEMES Research Group researchers
Publicada:
1 ene 2019
Categoría:
Cardiology and cardiovascular medicine
Resumen:
To determine short-term outcomes after an episode of acute heart failure in patients with mid-range ejection fraction (40%-49%; HFmrEF) compared with patients with reduced (< 40%) and preserved (> 49%) ejection fractions (HFrEF and HFpEF, respectively) and according to their final destination after emergency department (ED) care. This is an exploratory, secondary analysis of the Epidemiology of Acute Heart Failure in the Emergency departments Registry, which includes consecutive acute heart failure patients diagnosed in 41 Spanish EDs. Patients with echocardiography data were included and divided into HFrEF, HFmrEF, and HFpEF. The primary outcome was 30-day all-cause mortality, and secondary outcomes were in-hospital all-cause mortality, hospital length of stay > 10 days, and 30-day postdischarge ED revisit due to AHF and combined end point (ED revisit and/or death). We included 6,856 patients (age 79 [10]; 52.1% women): 21.6% had HFrEF, 14.3% HFmrEF, and 64.1% HFpEF. The main destinations for the 982 HFmrEF patients after ED management were internal medicine (293, 29.8%), cardiology (194, 19.9%) and not hospitalized (241, 24.5%), whereas the remaining 254 patients were admitted to other departments, including geriatric wards, short-stay units and intensive care units. Outcomes for HFmrEF did not differ compared with either HFrEF or HFpEF. Compared with HFmrEF admitted to cardiology, internal medicine admission or direct ED discharge increased the 30-day postdischarge ED revisit (hazard ratio [HR] 1.713, 95% confidence interval [CI] 1.042 to 2.816; and HR 1.683, 95% CI 1.046 to 2.708, respectively) and the 30-day postdischarge combined end point (HR 1.732, 95% CI 1.070 to 2.803; and HR 1.727, 95% CI 1.083 to 2.756, respectively). In conclusion, patients in the newly created HFmrEF category suffering from an acute decompensation have similar short-term outcomes as those in the classical HFrEF and HFpEF categories; nonetheless, HFmrEF patients handled in cardiology wards during decompensation obtain better outcomes, and reasons for these differences have to be unmasked and corrected. (C) 2018 Elsevier Inc. All rights reserved.
Filiaciones:
Miró Ò:
Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
Medical School, University of Barcelona, Spain
Javaloyes P:
Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
Gil V:
Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
Herrero P:
Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Marco-Hernández J:
Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
Ríos J:
Laboratory of Biostatistics Epidemiology, Universitat Autonoma de Barcelona
Medical Statistics Core Facility, IDIBAPS, Hospital Clínic, Barcelona, Spain
Harjola VP:
Emergency Medicine, Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
Torres-Gárate R:
Emergency Department, Hospital Severo Ochoa, Leganés, Madrid, Spain
Alonso MI:
Emergency Department, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
Piñera P:
Emergency Department, Hospital Reina Sofía, Murcia, Spain
Mecina AB:
Emergency Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
Escoda R:
Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
Müller C:
Cardiology Department, Hospital University of Basel, Switzerland
Parissis J:
Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
Llorens P:
Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
Medical School, Miguel Hernandez University, Elche, Alicante, Spain
ICA-SEMES Research Group researchers:
Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
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