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:
Miro, O, Harjola, P, Rossello, X, Gil, V, Jacob, J, Llorens, P, Martin-Sanchez, FJ, Herrero, P, Martinez-Nadal, G, Aguilo, S, Lopez-Grima, ML, Fuentes, M, Perez, JMA, Rodriguez-Adrada, E, Mir, M, Tost, J, Llauger, L, Ruschitzka, F, Harjola, VP, Mullens, W, Masip, J, Chioncel, O, Peacock, WF, Muller, C, Mebazaa, A, Alquezar A., Rizzi M.A., Herrera S., ICA-SEMES Res Grp
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:
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, Emergencies Proc & Pathol Res Grp,IDIBAPS, Villarroel 170, Barcelona 08036, Spain
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Harjola, P:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med & Serv, Emergency Med, Helsinki, Finland
Rossello, X:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Univ Hosp Son Espases, Cardiol Dept, Palma De Mallorca, Spain
Univ Hosp Son Espases, Hlth Res Inst Balearic Isl IdISBa, Palma De Mallorca, Spain
Gil, V:
Univ Barcelona, Hosp Clin, Emergency Dept, Emergencies Proc & Pathol Res Grp,IDIBAPS, Villarroel 170, Barcelona 08036, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Lhospitalet De Llobregat, Spain
Llorens, P:
Hosp Gen Alicante, Home Hospitalizat & Short Stay Unit, Emergency Dept, Alicante, Spain
Martin-Sanchez, FJ:
Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Univ Complutense Madrid, Inst Invest Sanitaria San Carlos IdISSC, Madrid, Spain
Herrero, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Martinez-Nadal, G:
Univ Barcelona, Hosp Clin, Emergency Dept, Emergencies Proc & Pathol Res Grp,IDIBAPS, Villarroel 170, Barcelona 08036, Spain
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Aguilo, S:
Univ Barcelona, Hosp Clin, Emergency Dept, Emergencies Proc & Pathol Res Grp,IDIBAPS, Villarroel 170, Barcelona 08036, Spain
Lopez-Grima, ML:
Hosp Dr Peset, Emergency Dept, Valencia, Spain
Fuentes, M:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Perez, JMA:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Rodriguez-Adrada, E:
Hosp Rey Juan Carlos Mostoles, Emergency Dept, Madrid, Spain
Mir, M:
Hosp Infanta Leonor, Emergency Dept, Madrid, Spain
Tost, J:
Hosp Terrassa, Emergency Dept, Barcelona, Spain
Llauger, L:
Hosp Vic, Emergency Dept, Barcelona, Catalonia, Spain
Ruschitzka, F:
Univ Spital Zurich, Univ Heart Ctr Zurich, Zurich, Switzerland
Harjola, VP:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med & Serv, Emergency Med, Helsinki, Finland
Mullens, W:
Univ Hasselt, Ziekenhuis Oost Limburg, Genk, Belgium
Masip, J:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Hosp Sanitas CIMA, Cardiol Dept, Barcelona, Catalonia, Spain
Chioncel, O:
Univ Med & Pharm Carol Davila, Emergency Inst Cardiovasc Dis Prof CC Iliescu, Bucharest, Romania
Peacock, WF:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Baylor Coll Med, Dept Emergency Med, Houston, TX 77030 USA
Muller, C:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland
Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel CRIB, Basel, Switzerland
Mebazaa, A:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Univ Paris Diderot, St Louis Lariboisiere Univ Hosp, InsermU942, Dept Anesthesiol & Crit Care Med,MASCOT, Paris, France
Alquezar A.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Rizzi M.A.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Herrera S.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Green Published
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