Impact of chronic renin-angiotensin-aldosterone inhibitors on short-term outcomes in patients with acute heart failure presenting to the emergency department. A propensity-matched analysis EAHFE cohort.

OBJECTIVES: The aim of the present study was to evaluate the impact of chronic treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on short-term clinical outcomes after an episode of AHF. METHODS: A secondary analysis of patients included in the EAHFE (Epidemiology of Acute Heart Failure in Emergency Departments) cohort, which includes patients diagnosed with AHF in 45 Spanish Emergency Departments (EDs). The primary outcome was all-cause in-hospital mortality. The secondary outcomes were all-cause death within 7 days, need for hospital admission and prolonged hospitalisation defined as a stay longer than or equal to 7 days. Multiple regression and propensity-matching was used for multivariate adjustment. RESULTS: Of the 17,920 patients, 10,041 (56 %) were receiving chronic treatment with ACEI/ARB. The mean age was 80.4 years and 55.7 % were women. Adjusted odds ratios (aOR) were 0.76 (95 % CI 0.71-0.82) for in-hospital mortality witch multiple regression and 0.74 (95 %CI 0.63-0.88) with propensity-matching. aOR were 0.72; (95 %CI 0.65-0.79) and 0.70 (95 %CI 0.57-0.87) for mortality at the 7-day follow-up, respectively. The sensitivity analysis ACEI/ARB were associated with few all-cause deaths in patients with elevated natriuretic peptides in the EDs (aOR 0.74; 95 % CI 0.68-0.80), patients requiring hospital admission (aOR 0.78; 95 % CI 0.73-0.84) and patients with a history of HF (aOR 0.72; 95 % CI 0.66-0.78). CONCLUSIONS: Chronic use of ACEI/ARB was associated with better short-term outcomes in terms of all-cause in-hospital mortality in patients with AHF who attend an EDs.

Short-term outcomes by chronic betablocker treatment in patients presenting to emergency departments with acute heart failure: BB-EAHFE.

AIMS: To evaluate the association between chronic treatment with betablockers (BB) and the severity of decompensation and short-term outcomes of patients with acute heart failure (AHF). METHODS AND RESULTS: We consecutively included all patients presenting with AHF to 45 Spanish emergency departments (ED) during six different time-periods between 2007 and 2018. Patients were stratified according to whether they were on chronic treatment with BB at the time of ED consultation. Those receiving BB were compared (adjusted odds ratio-OR-with 95% confidence interval-CI-) with those not receiving BB group in terms of in-hospital and 7-day all-cause mortality, need for hospitalization, and prolonged length of stay (≥7 days). Among the 17 923 recruited patients (median age: 80 years; 56% women), 7795 (43%) were on chronic treatment with BB. Based on the MEESSI-AHF risk score, those on BB were at lower risk. In-hospital mortality was observed in 1310 patients (7.4%), 7-day mortality in 765 (4.3%), need for hospitalization in 13 428 (75.0%), and prolonged length of stay (43.3%). After adjustment for confounding, those on chronic BB were at lower risk for in-hospital all-cause mortality (OR = 0.85, 95% CI = 0.79-0.92, P < 0.001); 7-day all-cause mortality (OR = 0.77, 95% CI = 0.70-0.85, P < 0.001); need for hospitalization (OR = 0.89, 95% CI = 0.85-0.94, P < 0.001); prolonged length of stay (OR = 0.90, 95% CI = 0.86-0.94, P < 0.001). A propensity matching approach yielded consistent findings. CONCLUSION: In patients presenting to ED with AHF, those on BB had better short-term outcomes than those not receiving BB.

Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020 - the Spanish ENCOVUR study. / Impacto organizativo de la pandemia COVID-19 de 2020 en los servicios de urgencias hospitalarios españoles: resultados del estudio ENCOVUR.

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.

OBJETIVO: Estimar el impacto del brote pandémico de COVID-19 en diversos aspectos organizativos de los servicios de urgencias hospitalarios (SUH) españoles e investigar si difirió en función de la comunidad autónoma, tamaño del hospital e incidencia local de la pandemia. METODO: Encuesta a los responsables de los 283 SUH españoles de uso público, quienes valoraron el impacto de la pandemia en aspectos organizativos, disponibilidad de recursos, y bajas del personal durante marzo-abril de 2020, diferenciando dicho impacto por quincenas. Los resultados se analizaron en conjunto, por comunidad autónoma, según tamaño del hospital y según incidencia local de la pandemia. RESULTADOS: Se recibieron 246 encuestas (87% de los SUH españoles). La mayoría de SUH reorganizaron el triaje, primera asistencia y observación y habilitó nuevos espacios específicos para pacientes con sospecha de COVID-19. Un 83% aumentó dotación enfermera (sin diferencias entre grupos) y un 59% la dotación de médicos (más frecuente en hospitales grandes y zonas de alta incidencia). El recurso que más escaseó fue el test diagnóstico de SARS-CoV-2 (55% del tiempo insuficiente con cierta o mucha frecuencia), seguido de mascarillas FPP2-FPP3 (38%), batas impermeables (34%) y espacio asistencial (32%). Hubo más del 5% de médicos/enfermería/otro personal de baja el 20%/19%/16% del tiempo. Estos déficits fueron máximos la segunda quincena de marzo, excepto para los test diagnósticos (primera quincena de marzo). Los SUH de grandes centros tuvieron menos escasez de tests diagnósticos, y los de zonas de alta incidencia pandémica más profesionales de baja. Existieron marcadas diferencias en todas estos déficits entre comunidades autónomas, no siempre concordantes con el grado de afectación pandémica en cada comunidad. CONCLUSIONES: La pandemia COVID-19 generó cambios estructurales en los SUH, que sufrieron una escasez considerable en ciertos recursos, con diferencias marcadas entre comunidades autónomas.