Departments involved during the first episode of acute heart failure and analysis of emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort
Por:
Miro, O, Sarasola, AG, Fuenzalida, C, Calderon, S, Jacob, J, Aguirre, A, Wu, D, Rizzi, MA, Malchair, P, Haro, A, Herrera, S, Gil, V, Martin-Sanchez, FJ, Llorens, P, Puente, PH, Bueno, H, Rodriguez, AD, Muller, CE, Mebazaa, A, Chioncel, O, Alquezar-Arbe, A, Fuentes, M, Gil, C, Alonso, H, Perez-Llantada, E, Martin-Sanchez, FJ, Garcia, GL, Cadenas, MS, Escoda, R, Xipell, C, Sanchez, C, Perez-Dura, MJ, Salvo, E, Pavon, J, Noval, A, Torres, JM, Lopez-Grima, ML, Valero, A, Juan, MA, Pedragosa, MA, Maso, SM, Alonso, MI, Ruiz, F, Franco, JM, Mecina, AB, Tost, J, Berenguer, M, Donea, R, Ramon, SS, Rodriguez, VC, Pinera, P, Nicolas, JAS, Garate, RT, Roset, A, Cabello, I, Richard, F, Perez, JMA, Diez, MPL, Alvarez, JV, Garcia, BP, Garcia, MG, Gonzalez, MS, Javaloyes, P, Marquina, V, Jimenez, I, Hernandez, N, Brouzet, B, Espinosa, B, Andueza, JA, Romero, R, Ruiz, M, Calvache, R, Serralta, MTL, Jave, LEC, Arriaga, BA, Bergua, BS, Mojarro, EM, Jimenez, BSA, Becquer, LT, Burillo, G, Garcia, LL, LaSalle, GC, Urbano, CA, Soto, ABG, Padial, ED, Ferrer, ES, Garrido, JM, Lucas-Imbernon, FJ, Gaya, R, Bibiano, C, Mir, M, Rodriguez, B, Carballo, JL, Rodriguez-Adrada, E, Miranda, BR
Publicada:
1 oct 2019
Ahead of Print:
1 ago 2019
Resumen:
Objectives We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. Methods and results We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (>= 3 times) or hospitalised (>= 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78). Conclusion In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.
Filiaciones:
Miro, O:
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Hosp Clin,Emergency Dept, Barcelona, Spain
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
Hosp Clin Barcelona, Barcelona, Spain
Sarasola, AG:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Fuenzalida, C:
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Hosp Clin,Emergency Dept, Barcelona, Spain
Calderon, S:
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Hosp Clin,Emergency Dept, Barcelona, Spain
Jacob, J:
Hosp Univ Bellvitge, Hosp Llobregat, Emergency Dept, Barcelona, Spain
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Aguirre, A:
Hosp Mar, Emergency Dept, Barcelona, Spain
Hosp Mar Barcelona, Barcelona, Spain
Wu, D:
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Hosp Clin,Emergency Dept, Barcelona, Spain
San Juan Bautista Sch Med, San Juan, PR USA
Rizzi, MA:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Malchair, P:
Hosp Univ Bellvitge, Hosp Llobregat, Emergency Dept, Barcelona, Spain
Haro, A:
Hosp Univ Bellvitge, Hosp Llobregat, Emergency Dept, Barcelona, Spain
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Herrera, S:
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Gil, V:
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Hosp Clin,Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
CNIC, Madrid, Spain
Llorens, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Hosp Gen Alicante, Alicante, Spain
Puente, PH:
Hosp Gen Alicante, Emergency Dept, Home Hospitalizat & Short Stay Unit, Alicante, Spain
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Bueno, H:
CNIC, Madrid, Spain
Univ Complutense, Hosp 12 Octubre, Cardiol Dept, Madrid, Spain
Rodriguez, AD:
Hosp Univ Canarias, Cardiol Dept, Tenerife, Spain
Muller, CE:
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Mebazaa, A:
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
Univ Paris Diderot, St Louis Lariboisiere Univ Hosp, Dept Anesthesiol & Crit Care Med, Paris, France
Chioncel, O:
Prof CC Iliescu Univ Med Carol Davila, Emergency Inst Cardiovasc Dis, Bucharest, Romania
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Fuentes, M:
Hosp Univ Salamanca, Salamanca, Spain
Gil, C:
Hosp Univ Salamanca, Salamanca, Spain
Alonso, H:
Hosp Marques Valdecilla Santander, Santander, Spain
Perez-Llantada, E:
Hosp Marques Valdecilla Santander, Santander, Spain
Martin-Sanchez, FJ:
Hosp Clin San Carlos Madrid, Madrid, Spain
Garcia, GL:
Hosp Clin San Carlos Madrid, Madrid, Spain
Cadenas, MS:
Hosp Clin San Carlos Madrid, Madrid, Spain
Escoda, R:
Hosp Clin Barcelona, Barcelona, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Sanchez, C:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Dura, MJ:
Hosp Politen La Fe Valencia, Valencia, Spain
Salvo, E:
Hosp Politen La Fe Valencia, Valencia, Spain
Pavon, J:
Hosp Dr Negrin Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Noval, A:
Hosp Insular Palmas Gran Canaria, Las Palmas Gran Canaria, Spain
Torres, JM:
Hosp Reina Sofia Cordoba, Cordoba, Spain
Lopez-Grima, ML:
Hosp Dr Peset Valencia, Valencia, Spain
Valero, A:
Hosp Dr Peset Valencia, Valencia, Spain
Juan, MA:
Hosp Dr Peset Valencia, Valencia, Spain
Pedragosa, MA:
Hosp Mar Barcelona, Barcelona, Spain
Maso, SM:
Hosp Mar Barcelona, Barcelona, Spain
Alonso, MI:
Hosp Valme Sevilla, Seville, Spain
Ruiz, F:
Hosp Valme Sevilla, Seville, Spain
Franco, JM:
Hosp Miguel Servet Zaragoza, Zaragoza, Spain
Mecina, AB:
Hosp Alcorcon Madrid, Madrid, Spain
Tost, J:
ConsorciSanitari Terrassa, Barcelona, Spain
Berenguer, M:
ConsorciSanitari Terrassa, Barcelona, Spain
Donea, R:
ConsorciSanitari Terrassa, Barcelona, Spain
Ramon, SS:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Rodriguez, VC:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia Murcia, Murcia, Spain
Nicolas, JAS:
Hosp Reina Sofia Murcia, Murcia, Spain
Garate, RT:
Hosp Severo Ochoa Madrid, Madrid, Spain
Roset, A:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Cabello, I:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Richard, F:
Hosp Univ Burgos, Burgos, Spain
Perez, JMA:
Hosp Univ Burgos, Burgos, Spain
Diez, MPL:
Hosp Univ Burgos, Burgos, Spain
Alvarez, JV:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, BP:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, MG:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Gonzalez, MS:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Javaloyes, P:
Hosp Gen Alicante, Alicante, Spain
Marquina, V:
Hosp Gen Alicante, Alicante, Spain
Jimenez, I:
Hosp Gen Alicante, Alicante, Spain
Hernandez, N:
Hosp Gen Alicante, Alicante, Spain
Brouzet, B:
Hosp Gen Alicante, Alicante, Spain
Espinosa, B:
Hosp Gen Alicante, Alicante, Spain
Andueza, JA:
Hosp Gen Univ Gregorio Maranon Madrid, Madrid, Spain
Romero, R:
Hosp Univ Getafe Madrid, Madrid, Spain
Ruiz, M:
Hosp Henares Madrid, Madrid, Spain
Calvache, R:
Hosp Henares Madrid, Madrid, Spain
Serralta, MTL:
Hosp Tajo Madrid, Madrid, Spain
Jave, LEC:
Hosp Tajo Madrid, Madrid, Spain
Arriaga, BA:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Bergua, BS:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Mojarro, EM:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Jimenez, BSA:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Becquer, LT:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Burillo, G:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Garcia, LL:
Hosp Univ Vic Barcelona, Barcelona, Spain
LaSalle, GC:
Hosp Univ Vic Barcelona, Barcelona, Spain
Urbano, CA:
Hosp Costa Sol Marbella Malaga, Malaga, Spain
Soto, ABG:
Hosp Costa Sol Marbella Malaga, Malaga, Spain
Padial, ED:
Hosp Costa Sol Marbella Malaga, Malaga, Spain
Ferrer, ES:
Hosp Josep Trueta Girona, Girona, Spain
Garrido, JM:
Hosp Virgen Macarena Sevilla, Seville, Spain
Lucas-Imbernon, FJ:
Hosp Gen Univ Albacete, Albacete, Spain
Gaya, R:
Hosp Juan XXIII Tarragona, Tarragona, Spain
Bibiano, C:
Hosp Infanta Leonor Madrid, Madrid, Spain
Mir, M:
Hosp Infanta Leonor Madrid, Madrid, Spain
Rodriguez, B:
Hosp Infanta Leonor Madrid, Madrid, Spain
Carballo, JL:
Complejo Hosp Univ Ourense, Orense, Spain
Rodriguez-Adrada, E:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Miranda, BR:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Green Accepted
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