Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort. (7th August 2019)

• Record Type: Journal Article
• Authors: Miró, Òscar; García Sarasola, Ana; Fuenzalida, Carolina; Calderón, Sofía; Jacob, Javier; Aguirre, Alfons; Wu, Da M.; Rizzi, Miguel A.; Malchair, Pierre; Haro, Antonio; Herrera, Sergio; Gil, Víctor; Martín‐Sánchez, Francisco J.; Llorens, Pere; Herrero Puente, Pablo; Bueno, Héctor; Domínguez Rodríguez, Alberto; Müller, Christian E.; Mebazaa, Alexandre; Chioncel, Ovidiu; Alquézar‐Arbé, Aitor
• Other Names: Fuentes Marta investigator.; Gil Cristina investigator.; Alonso Héctor investigator.; Pérez‐Llantada Enrique investigator.; Martín‐Sánchez Francisco Javier investigator.; García Guillermo Llopis investigator.; Cadenas Mar Suárez investigator.; Miró Òscar investigator.; Gil Víctor investigator.; Escoda Rosa investigator.; Xipell Carolina investigator.; Sánchez Carolina investigator.; Pérez‐Durá María José investigator.; Salvo Eva investigator.; Pavón José investigator.; Noval Antonio investigator.; Torres José Manuel investigator.; López‐Grima María Luisa investigator.; Valero Amparo investigator.; Juan María ángeles investigator.; Aguirre Alfons investigator.; Pedragosa Maria Àngels investigator.; Masó Silvia Mínguez investigator.; Alonso María Isabel investigator.; Ruiz Francisco investigator.; Franco José Miguel investigator.; Mecina Ana Belén investigator.; Tost Josep investigator.; Berenguer Marta investigator.; Donea Ruxandra investigator.; Ramón Susana Sánchez investigator.; Rodríguez Virginia Carbajosa investigator.; Piñera Pascual investigator.; Nicolás José Andrés Sánchez investigator.; Garate Raquel Torres investigator.; Alquézar‐Arbé Aitor investigator.; Rizzi Miguel Alberto investigator.; Herrera Sergio investigator.; Jacob Javier investigator.; Roset Alex investigator.; Cabello Irene investigator.; Haro Antonio investigator.; Richard Fernando investigator.; Pérez José María álvarez investigator.; Diez María Pilar López investigator.; Puente Pablo Herrero investigator.; álvarez Joaquín Vázquez investigator.; García Belén Prieto investigator.; García María García investigator.; González Marta Sánchez investigator.; Llorens Pere investigator.; Javaloyes Patricia investigator.; Marquina Víctor investigator.; Jiménez Inmaculada investigator.; Hernández Néstor investigator.; Brouzet Benjamín investigator.; Espinosa Begoña investigator.; Andueza Juan Antonio investigator.; Romero Rodolfo investigator.; Ruíz Martín investigator.; Calvache Roberto investigator.; Serralta María Teresa Lorca investigator.; Jave Luis Ernesto Calderón investigator.; Arriaga Beatriz Amores investigator.; Bergua Beatriz Sierra investigator.; Mojarro Enrique Martín investigator.; Jiménez Brigitte Silvana Alarcón investigator.; Bécquer LisetteTravería investigator.; Burillo Guillermo investigator.; García Lluís Llauger investigator.; LaSalle Gerard Corominas investigator.; Urbano Carmen Agüera investigator.; Soto Ana Belén García investigator.; Padial Elisa Delgado investigator.; Ferrer Ester Soy investigator.; Garrido José Manuel investigator.; Lucas‐Imbernón Francisco Javier investigator.; Gaya Rut investigator.; Bibiano Carlos investigator.; Mir María investigator.; Rodríguez Beatriz investigator.; Carballo José Luis investigator.; Rodríguez‐Adrada Esther investigator.; Miranda Belén Rodríguez investigator.;
• Is Part Of: European journal of heart failure. Volume 21:Number 10(2019)
• Page Start: 1231
• Page End: 1244
• Publication Date: 2019-08-07
• Subjects: Heart failure -- De novo acute heart failure -- Hospitalisation -- Rehospitalisation -- Emergency department -- Mortality; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.1567
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : Objectives: We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. Methods and results: We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post‐discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In‐hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5–4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF‐related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF‐related). AHF‐related hospitalisations were mainly in internal medicine (28.0%), short‐stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF‐related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations ( P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17–2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26–5.38) and anaemia (OR 2.39, 95% CI 1.51–3.78). Conclusion: In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.