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

Autor:	López Díez MP; Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España., Llorens P; Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España., Martín-Sánchez FJ; Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España., Gil V; Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España., Jacob J; Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España., Herrero P; Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España., Llauger L; Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España., Tost J; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, España., Aguirre A; Servicio de Urgencias, Hospital del Mar, Barcelona, España., Garrido JM; Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, España., Vega JA; Servicio de Urgencias, Hospital Universitario Reina Sofía, Córdoba, España., Fuentes M; Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España., Alonso MI; Servicio de Urgencias, Hospital Valme, Sevilla, España., López Grima ML; Servicio de Urgencias, Hospital Dr. Peset, Valencia, España., Piñera P; Servicio de Urgencias, Hospital Universitario Reina Sofía, Murcia, España., Romero R; Servicio de Urgencias, Hospital Universitario de Getafe, Universidad Europea, Madrid, España., Lucas-Imbernón FJ; Servicio de Urgencias, Hospital Universitario de Albacete, Albacete, España., Andueza JA; Servicio de Urgencias, Hospital Universitario Dr. Gregorio Marañón, Madrid, España., Povar J; Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España., Richard F; Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España., Sánchez C; Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España., Miró Ò; Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España.
Jazyk:	English; Spanish; Castilian
Zdroj:	Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias [Emergencias] 2022 Oct; Vol. 34 (5), pp. 345-351.
Abstrakt:	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. Material and 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 internal 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.
Databáze:	MEDLINE
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