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 (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. Material and methods: Secondary analysis of discharge records in the Older AH...

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Autores: Martín Sánchez, Francisco Javier, Parra Esquivel, Patricia, Llopis García, Guillermo, González del Castillo, Juan, Rodriguez Adrada, Esther, Espinosa, Begoña, López Diez, María Pilar, Romero Pareja, Rodolfo, Rizzi Bordigoni, Miguel Alberto, Pérez-Durá, María José, Bibiano, Carlos, Ferrer, Carles, Aguiló, Sira, Martín Mojarro, Enrique, Aguirre Tejedo, Alfons, Piñera, Pascual, López-Picado, Amanda, Llorens, Pere, Jacob, Javier, Gil, Víctor, Herrero Puente, Pablo, Fernandez Pérez, Cristina, Gil, Pedro, Calvo, Elpidio, Rossello, Xavier, Bueno, Hector, Burillo Putze, Guillermo, Miró i Andreu, Òscar
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/199507
Acceso en línea:https://hdl.handle.net/2445/199507
Access Level:acceso abierto
Palabra clave:Insuficiència cardíaca
Persones grans
Serveis d'urgències hospitalàries
Heart failure
Older people
Hospital emergency services
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spelling 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 trialMartín Sánchez, Francisco JavierParra Esquivel, PatriciaLlopis García, GuillermoGonzález del Castillo, JuanRodriguez Adrada, EstherEspinosa, BegoñaLópez Diez, María PilarRomero Pareja, RodolfoRizzi Bordigoni, Miguel AlbertoPérez-Durá, María JoséBibiano, CarlosFerrer, CarlesAguiló, SiraMartín Mojarro, EnriqueAguirre Tejedo, AlfonsPiñera, PascualLópez-Picado, AmandaLlorens, PereJacob, JavierGil, VíctorHerrero Puente, PabloFernandez Pérez, CristinaGil, PedroCalvo, ElpidioRossello, XavierBueno, HectorBurillo Putze, GuillermoMiró i Andreu, ÒscarInsuficiència cardíacaPersones gransServeis d'urgències hospitalàriesHeart failureOlder peopleHospital emergency servicesObjectives: To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. Material and 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. Highrisk 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% CI, -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% CI, -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.Saned2023202320212023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion9 p.application/pdfhttps://hdl.handle.net/2445/199507Articles publicats en revistes (Ciències Clíniques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://europepmc.org/article/med/33978329Emergencias, 2021, vol. 33, num. 3, p. 165-173(c) Saned, 2021info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1995072026-05-29T05:05:01Z
dc.title.none.fl_str_mv 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
title 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
spellingShingle 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
Martín Sánchez, Francisco Javier
Insuficiència cardíaca
Persones grans
Serveis d'urgències hospitalàries
Heart failure
Older people
Hospital emergency services
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
dc.creator.none.fl_str_mv Martín Sánchez, Francisco Javier
Parra Esquivel, Patricia
Llopis García, Guillermo
González del Castillo, Juan
Rodriguez Adrada, Esther
Espinosa, Begoña
López Diez, María Pilar
Romero Pareja, Rodolfo
Rizzi Bordigoni, Miguel Alberto
Pérez-Durá, María José
Bibiano, Carlos
Ferrer, Carles
Aguiló, Sira
Martín Mojarro, Enrique
Aguirre Tejedo, Alfons
Piñera, Pascual
López-Picado, Amanda
Llorens, Pere
Jacob, Javier
Gil, Víctor
Herrero Puente, Pablo
Fernandez Pérez, Cristina
Gil, Pedro
Calvo, Elpidio
Rossello, Xavier
Bueno, Hector
Burillo Putze, Guillermo
Miró i Andreu, Òscar
author Martín Sánchez, Francisco Javier
author_facet Martín Sánchez, Francisco Javier
Parra Esquivel, Patricia
Llopis García, Guillermo
González del Castillo, Juan
Rodriguez Adrada, Esther
Espinosa, Begoña
López Diez, María Pilar
Romero Pareja, Rodolfo
Rizzi Bordigoni, Miguel Alberto
Pérez-Durá, María José
Bibiano, Carlos
Ferrer, Carles
Aguiló, Sira
Martín Mojarro, Enrique
Aguirre Tejedo, Alfons
Piñera, Pascual
López-Picado, Amanda
Llorens, Pere
Jacob, Javier
Gil, Víctor
Herrero Puente, Pablo
Fernandez Pérez, Cristina
Gil, Pedro
Calvo, Elpidio
Rossello, Xavier
Bueno, Hector
Burillo Putze, Guillermo
Miró i Andreu, Òscar
author_role author
author2 Parra Esquivel, Patricia
Llopis García, Guillermo
González del Castillo, Juan
Rodriguez Adrada, Esther
Espinosa, Begoña
López Diez, María Pilar
Romero Pareja, Rodolfo
Rizzi Bordigoni, Miguel Alberto
Pérez-Durá, María José
Bibiano, Carlos
Ferrer, Carles
Aguiló, Sira
Martín Mojarro, Enrique
Aguirre Tejedo, Alfons
Piñera, Pascual
López-Picado, Amanda
Llorens, Pere
Jacob, Javier
Gil, Víctor
Herrero Puente, Pablo
Fernandez Pérez, Cristina
Gil, Pedro
Calvo, Elpidio
Rossello, Xavier
Bueno, Hector
Burillo Putze, Guillermo
Miró i Andreu, Òscar
author2_role author
author
author
author
author
author
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 Insuficiència cardíaca
Persones grans
Serveis d'urgències hospitalàries
Heart failure
Older people
Hospital emergency services
topic Insuficiència cardíaca
Persones grans
Serveis d'urgències hospitalàries
Heart failure
Older people
Hospital emergency services
description Objectives: To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. Material and 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. Highrisk 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% CI, -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% CI, -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.
publishDate 2021
dc.date.none.fl_str_mv 2021
2023
2023
2023
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://hdl.handle.net/2445/199507
url https://hdl.handle.net/2445/199507
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://europepmc.org/article/med/33978329
Emergencias, 2021, vol. 33, num. 3, p. 165-173
dc.rights.none.fl_str_mv (c) Saned, 2021
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Saned, 2021
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 9 p.
application/pdf
dc.publisher.none.fl_str_mv Saned
publisher.none.fl_str_mv Saned
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.811543

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