Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis

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...

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Autores: Diez, MPL, Llorens, P, Martin-Sanchez, FJ, Gil, V, Jacob, J, Herrero, P, Llauger, L, Tost, J, Aguirre, A, Garrido, JM, Vega, JA, Fuentes, M, Alonso, MI, Grima, MLL, Pinera, P, Romero, R, Lucas-Imbernon, FJ, Andueza, JA, Povar, J, Richard, F, Sanchez, C, Miro, O
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
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:p9344
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones9344
Access Level:acceso abierto
Palabra clave:Acute heart failure
Congestive heart failure
Signs
Mortality
Emergency health services
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spelling Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosisDiez, MPLLlorens, PMartin-Sanchez, FJGil, VJacob, JHerrero, PLlauger, LTost, JAguirre, AGarrido, JMVega, JAFuentes, MAlonso, MIGrima, MLLPinera, PRomero, RLucas-Imbernon, FJAndueza, JAPovar, JRichard, FSanchez, CMiro, OAcute heart failureCongestive heart failureSignsMortalityEmergency health servicesObjectives. 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.Soc Espanola Medicina Urgencias & Emergencias-SEMES2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://isabial.portalinvestigacion.com/publicaciones9344EmergenciasISSN: 11376821ISSNe: 23865857reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicanteinstname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)Españolinfo:eu-repo/semantics/openAccessoai:isabial.fundanetsuite.com:p93442026-06-12T10:20:37Z
dc.title.none.fl_str_mv Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
title Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
spellingShingle Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
Diez, MPL
Acute heart failure
Congestive heart failure
Signs
Mortality
Emergency health services
title_short Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
title_full Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
title_fullStr Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
title_full_unstemmed Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
title_sort Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
dc.creator.none.fl_str_mv Diez, MPL
Llorens, P
Martin-Sanchez, FJ
Gil, V
Jacob, J
Herrero, P
Llauger, L
Tost, J
Aguirre, A
Garrido, JM
Vega, JA
Fuentes, M
Alonso, MI
Grima, MLL
Pinera, P
Romero, R
Lucas-Imbernon, FJ
Andueza, JA
Povar, J
Richard, F
Sanchez, C
Miro, O
author Diez, MPL
author_facet Diez, MPL
Llorens, P
Martin-Sanchez, FJ
Gil, V
Jacob, J
Herrero, P
Llauger, L
Tost, J
Aguirre, A
Garrido, JM
Vega, JA
Fuentes, M
Alonso, MI
Grima, MLL
Pinera, P
Romero, R
Lucas-Imbernon, FJ
Andueza, JA
Povar, J
Richard, F
Sanchez, C
Miro, O
author_role author
author2 Llorens, P
Martin-Sanchez, FJ
Gil, V
Jacob, J
Herrero, P
Llauger, L
Tost, J
Aguirre, A
Garrido, JM
Vega, JA
Fuentes, M
Alonso, MI
Grima, MLL
Pinera, P
Romero, R
Lucas-Imbernon, FJ
Andueza, JA
Povar, J
Richard, F
Sanchez, C
Miro, O
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Acute heart failure
Congestive heart failure
Signs
Mortality
Emergency health services
topic Acute heart failure
Congestive heart failure
Signs
Mortality
Emergency health services
description 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.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://isabial.portalinvestigacion.com/publicaciones9344
url https://isabial.portalinvestigacion.com/publicaciones9344
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Soc Espanola Medicina Urgencias & Emergencias-SEMES
publisher.none.fl_str_mv Soc Espanola Medicina Urgencias & Emergencias-SEMES
dc.source.none.fl_str_mv Emergencias
ISSN: 11376821
ISSNe: 23865857
reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
instname_str Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
reponame_str r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
collection r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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