ABSTRACT
BACKGROUND: Patients with acute heart failure (AHF) are frequently evaluated in the Emergency Departments (ED) and discharged from their observation units (OU) without hospital admission. We examined direct discharge rates from the ED OU, risk factors for returning to the ED, and returning and mortality rates. PATIENTS AND METHODS: This prospective, longitudinal, noninterventional, population-based cohort study included all the patients with AHF consecutively attended in seven Spanish EDs who were directly discharged without hospital admission. Reattendance (dependent variable) was accepted if occurred during the next 30 days after discharge. Twenty-nine independent variables were recorded, covering epidemiological, clinical, and functional data. RESULTS: Two hundred and fifty-nine of 740 patients (35%) diagnosed with AHF were entirely managed in the ED OU and discharged home (mean stay: 18.8 h); 26.7% of them were reattended. Only three variables were independently associated with the chance of reattendance: functional impairment predicted adverse outcomes [odds ratio (OR): 4.0, 95% confidence interval (95% CI): 1.7-9.1], while past history of hypertension and a systolic blood pressure greater than 160 mmHg at ED arrival decreased the risk of ED return (OR: 0.4, 95% CI: 0.2-0.9; and OR: 0.3; 95% CI: 0.1-0.9; respectively). An overall mortality of 4.7% was recorded during the next 30 days. CONCLUSION: One-third of the patients consulting at the ED for an episode of AHF can be directly discharged from the OU of ED, with relatively low rates of reattendance (26.7%) and mortality (4.7%). Emergency physicians should be especially cautious discharging patients with functional dependence because they are at increased risk of returning.
Subject(s)
Heart Failure , Patient Readmission , Acute Disease , Aged , Aged, 80 and over , Cohort Studies , Emergency Service, Hospital/standards , Female , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Outcome and Process Assessment, Health Care , Prospective Studies , Risk FactorsABSTRACT
Introducción y objetivos. Investigar los factores asociados a la mortalidad a corto plazo en los pacientes ancianos que acuden a urgencias por un episodio de insuficiencia cardiaca aguda. Métodos. Estudio de cohortes, analítico-prospectivo, multicéntrico y sin intervención. Se incluyó a pacientes de 65 o más años atendidos en ocho servicios de urgencias de hospitales terciarios españoles. Se analizaron 28 variables independientes (epidemiológicas, clínicas y funcionales) que pudieran influir en la mortalidad a 30 días. Los datos se obtuvieron mediante la consulta de la historia clínica o la entrevista con el paciente o su familia. Se realizó un estudio multivariable mediante regresión logística. Resultados. Se incluyó a 623 pacientes, de los que 42 (6,7%) habían fallecido a los 30 días de la consulta en urgencias. Cuatro variables se asociaron de forma significativa con la mortalidad: la dependencia funcional basal (índice de Barthel ≤ 60, odds ratio [OR] = 2,9; intervalo de confianza [IC] del 95%, 1,2-6,5), clases III y IV de la NYHA (OR = 3; IC del 95%, 1,3-7), presión arterial sistólica < 100 mmHg (OR = 4,8; IC del 95%, 1,6-14,5) y natremia < 135 mEq/l (OR = 4,2; IC del 95%, 1,8-9,6). Conclusiones. Existen diversos factores disponibles tras una primera valoración en urgencias, entre ellos la dependencia funcional del paciente, que determinan un mal pronóstico a corto plazo del paciente anciano que consulta por un episodio de insuficiencia cardiaca aguda (AU)
Introduction and objectives. To investigate factors associated with short-term mortality in elderly patients seen in emergency departments for an episode of acute heart failure.Methods. A prospective, non-interventional, multicenter, cohort study was carried out in patients aged 65 years and older who were treated in the emergency department of one of eight tertiary hospitals in Spain. Twenty-eight independent variables that could influence mortality at 30 days were assessed. They covered epidemiological and clinical factors and daily functioning. Data were obtained by reviewing medical records or by interviewing the patient or a relative. Multivariate logistic regression analysis was performed.Results. The study included 623 patients, 42 of whom (6.7%) died within 30 days of visiting the emergency department. Four variables were significantly associated with higher mortality: functional dependence at baseline (i.e., Barthel index=60; odds ratio [OR]=2.9; 95% confidence interval [CI], 1.2-6.5), New York Heart Association class (..) (AU)