IMPROVED study outcomes after discharge for an e

Authors: Òscar Miró Víctor Gil Carolina Xipell Carolina Sánchez Sira Aguiló Francisco J MartínSánchez Pablo Herrero Javier Jacob Alexandre Mebazaa VeliPekka Harjola Pere Llorens ICASEMES Research Group

Publish Date: 2016/12/22

Volume: 106, Issue: 5, Pages: 369-378

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Abstract

To define the short and midterm outcomes of patients discharged after an episode of acutedecompensated heart failure ADHF and evaluate the differences between patients discharged directly from the emergency department ED and those discharged after hospitalizationWe performed a prospective multicenter cohortdesigned study including consecutive patients diagnosed with ADHF in 27 Spanish EDs Thirtyfour variables on epidemiology comorbidity baseline status vital signs signs of congestion laboratory tests and treatment were collected in every patient The primary outcome was a combined endpoint of ED revisit without hospitalization or hospitalization due to ADHF or allcause death Secondary outcomes were each of these three events individually Outcomes were obtained by survival analysis at different timepoints in the entire cohort and crude and adjusted comparisons were carried out between patients discharged directly from the ED and after hospitalizationOf the 3233 patients diagnosed with ADHF during a 2month period we analyzed 2986 patients discharged alive 787 264 discharged from the ED and 2199 736 after hospitalization The cumulative percentages of events for the whole cohort at 7/30/180 days for the combined endpoint were 78/247/578 for ED revisit 25/94/255 for hospitalization 46/153/407 and for death 09/43/168 After adjustment for patient profile and center significant increases were found in the hazard ratios for ED compared to hospitaldischarged patients in the combined endpoint ED revisit and hospitalization being higher at shortterm at 7 days 2373 1678–3355 2069 1188–3602 and 3071 1915–4922 respectively than at midterm at 180 days 1368 1160–1614 1642 1265–2132 and 1302 1044–1623 respectively No significant differences were found in deathPatients with ADHF discharged from the ED have worse outcomes especially at short term than those discharged after hospitalization The definition and implementation of effective strategies to improve patient selection for direct ED discharge are neededThis study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER PI10/01918 PI11/01021 PI15/01019 and PI15/00773 and La Marató de TV3 2015/2510 The Emergencies processes and pathologies research group of the IDIBAPS receives financial support from the Catalonia Govern for Consolidated Groups of Investigation GRC 2009/1385 and 2014/0313Other investigators of the ICASEMES research group Marta Fuentes Cristina Gil Hospital Universitario de Salamanca María José Pérezdurá Eva Salvo José Vallés Hospital La Fe de Valencia Rosa Escoda Hospital Clinic de Barcelona José Pavón Ana Bella Álvarez Hospital Dr Negrín de Las Palmas de Gran Canaria Antonio Noval Hospital Insular de Las Palmas de Gran Canaria José M Torres Hospital Reina Sofía de Córdoba Maria Luisa LópezGrima Amparo Valero Hospital Dr Peset de Valencia Alfons Aguirre Maria Àngels Pedragosa Hospital del Mar de Barcelona Maria Isabel Alonso Helena Sancho Paco Ruiz Hospital de Valme de Sevilla Antonio Giménez José Miguel Franco Hospital Miguel Servet de Zaragoza Sergio Pardo Hospital San Juan de Alicante Ana Belen Mecina Hospital de Alcorcón Josep Tost Consorci Sanitari de Terrassa Jordi Fabregat Hospital Mutua de Terrasa Susana Sánchez Hospital Rio Ortega de Valladolid Pascual Piñera Hospital Reina Sofia de Murcia Raquel Torres Garate Hospital Severo Ochoa Aitor Alquezar Miguel Alberto Rizzi Hospital San Pau de Barcelona Fernando Richard Hospital de Burgos Javier Lucas Hospital General de Albacete Irene Cabello Hospital Universitari de Bellvitge BarcelonaEsther RodríguezAdrada Hospital Clínico San Carlos Madrid José Manuel Garrido Hospital Virgen de la Macarena SevillaThe authors state that they have no conflict of interests with the present work The ICASEMES Research Group has received unrestricted support from Orion Pharma and Novartis The present study has been designed performed analyzed and written exclusively by the authors independently from these pharmaceutical companies

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