The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department
Por:
Miró Ò, Harjola P, Rossello X, Gil V, Jacob J, Llorens P, Martín-Sánchez FJ, Herrero P, Martínez-Nadal G, Aguiló S, López-Grima ML, Fuentes M, Álvarez Pérez JM, Rodríguez-Adrada E, Mir M, Tost J, Llauger L, Ruschitzka F, Harjola VP, Mullens W, Masip J, Chioncel O, Peacock WF, Müller C, Mebazaa A and ICA-SEMES Research Group
Publicada:
1 may 2021
Ahead of Print:
1 ene 2021
Resumen:
Aims The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED.
Methods and results In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL=7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085-1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146-1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995-1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817-1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845-1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915-1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings.
Conclusion Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.
Filiaciones:
Miró Ò:
Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Harjola P:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Department of Emergency Medicine and Services, Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Rossello X:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Cardiology Department & Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain
Gil V:
Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
Llorens P:
Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
Herrero P:
Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Martínez-Nadal G:
Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Aguiló S:
Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
:
Emergency Department, Hospital Dr. Peset, Valencia, Spain
Fuentes M:
Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
Álvarez Pérez JM:
Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
Rodríguez-Adrada E:
Emergency Department, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
Mir M:
Emergency Department, Hospital Infanta Leonor, Madrid, Spain
Tost J:
Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
Llauger L:
Emergency Department, Hospital de Vic, Barcelona, Catalonia, Spain
Ruschitzka F:
UniversitätsSpital Zürich, University Heart Center Zurich, Zurich, Switzerland
Harjola VP:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Department of Emergency Medicine and Services, Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Mullens W:
Ziekenhuis Oost Limburg, University Hasselt, Genk, Belgium
Masip J:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Cardiology Department, Hospital Sanitas CIMA, Barcelona, Catalonia, Spain
Chioncel O:
Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
Peacock WF:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
Müller C:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
Mebazaa A:
The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
Department of Anesthesiology and Critical Care Medicine, InsermU942-MASCOT, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
Green Published, Bronze
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