Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial
Objectives. To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (Al-IF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. Methods. Secondary analysis of discharge records in the Older AHF Key Data...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2021 |
| País: | España |
| Institución: | Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL) |
| Repositorio: | r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante |
| OAI Identifier: | oai:isabial.fundanetsuite.com:p7522 |
| Acceso en línea: | https://isabial.portalinvestigacion.com/publicaciones7522 http://emergencias.portalsemes.org/descargar/resultados-a-30-das-en-los-pacientes-mayores-frgiles-con-insuficiencia-cardiaca-aguda-dados-de-alta-desde-urgencias-o-sus-unidades-vinculadas-que-cumplen-los-criterios-de-alto-riesgo-del-estudio-deed-frailahf/ |
| Access Level: | acceso abierto |
| Palabra clave: | Frail elderly Acute heart failure Aged Emergency department |
| Sumario: | Objectives. To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (Al-IF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. Methods. Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. Results. We included 380 patients with a mean (SD) age of 86(5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30 -day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. High-risk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P=.092; 27.6% vs 16.7%, P=.010; and 24.7% vs 15.2%, P=.098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P=.011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P=.127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P =.005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30 -day DAOH, -1.3 days (95% Cl, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% Cl, -2.1% to 18.7%). Conclusion. Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis. |
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