Impact of congestion and perfusion status in the emergency department on severity of decompensation and short-term prognosis in patients with acute heart failure.
Por:
Espinosa B, Llorens P, Gil V, Jacob J, Alquézar-Arbé A, Masip J, Llauger L, Tost J, Andueza JA, Garrido JM, Soy-Ferrer E, Agüera-Urbano C, Herrero P, Gil-Rodrigo A, Millán J, Mecina AB, Torres-Gárate R, Cabrera-González N, Núñez J and Miró Ò
Publicada:
3 abr 2023
Ahead of Print:
22 sep 2022
Resumen:
OBJECTIVES: To assess whether symptoms/signs of congestion and perfusion in acute heart failure (AHF) evaluated at patient arrival to the emergency department (ED) can predict the severity of decompensation and short-term outcomes. METHODS: We included patients from the Epidemiology of Acute Heart Failure Emergency Registry (EAHFE Registry). We registered 7 clinical surrogates of congestion and 5 of hypoperfusion. Patients were grouped according to severity of congestion/hypoperfusion. We assessed the need for hospitalization, in-hospital all-cause mortality for patients needing hospitalization, and prolonged hospitalization for patients surviving the decompensation episode. Outcomes were adjusted for patient characteristics and the coexistence of congestion and hypoperfusion. RESULTS: We analyzed 18,120 patients (median = 83 years, IQR = 76-88; women = 55.7%). 72% presented >2 signs/symptoms of congestion and 18% had at least 1 sign/symptom of hypoperfusion. 75% were hospitalized with in-hospital death in 9% and prolonged hospitalization in 47% discharged alive. The presence of congestion/hypoperfusion were independently associated with poorer outcomes. An increase in the number of signs/symptoms of congestion was associated with increased risk of hospitalization (p < 0.001) and prolonged stay (p = 0.011), but not mortality (p = 0.06). Increased signs/symptoms of hypoperfusion was associated with hospitalization (p < 0.001) and mortality (p < 0.001), but not prolonged stay (p = 0.227). In the combined model, including congestion and hypoperfusion, both had additive effects on hospitalization, in-hospital mortality was driven by hypoperfusion and no differences were observed for prolonged hospitalization. CONCLUSION: The presence of congestion/hypoperfusion at ED arrival is a simple clinical marker associated with a higher risk of severity/adverse short-term outcomes.
Filiaciones:
:
Emergency Service, Short Stay and Hospitalization at Home, General Hospital Dr Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Miguel Hernández University, Alicante, Spain
:
Emergency Service, Short Stay and Hospitalization at Home, General Hospital Dr Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Miguel Hernández University, Alicante, Spain
Gil V:
Emergency Area, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
Jacob J:
Emergency Department, Bellvitge University Hospital, l'Hospitalet de Llobregat, Barcelona, Spain
Alquézar-Arbé A:
Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Masip J:
Cardiology Service, Research Direction Consorci Sanitari Integral, Barcelona, Spain
Llauger L:
Emergency Department, Vic Hospital, Barcelona, Spain
Tost J:
Emergency Service. Sanitary Consortium, Terrassa, Spain
Andueza JA:
Emergency Service. Hospital General Universitario Gregorio Marañón, Madrid, Spain
Garrido JM:
Emergency Service. Hospital Virgen Macarena, Seville, Spain
Soy-Ferrer E:
Emergency Service. Josep Trueta Hospital, Girona, Spain
Agüera-Urbano C:
Emergency Service. Hospital Costa del Sol, Marbella, Malaga, Spain
Herrero P:
Emergency Service. Central Hospital of Asturias, Oviedo, Spain
:
Emergency Service, Short Stay and Hospitalization at Home, General Hospital Dr Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Miguel Hernández University, Alicante, Spain
Millán J:
Emergency Service. La Fe University and Politechnic Hospital, Valencia, Spain
Mecina AB:
Emergency Service. Alcorcón Foundation University Hospital, Madrid, Spain
Torres-Gárate R:
Emergency Service. Severo Ochoa Hospital, Madrid, Spain
Cabrera-González N:
Emergency Service. Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
Núñez J:
Cardiology Department, University Clinical Hospital of Valencia, University of Valencia, INCLIVA, Valencia, Spain
Miró Ò:
Emergency Area, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
Open Access
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