Acute decompensated heart failure in the emergency department

Castello, Luigi Mario; Molinari, Luca; Renghi, Alessandra; Peruzzi, Elena; Capponi, Andrea; Avanzi, Gian Carlo; Pirisi, Mario

doi:10.1097/md.0000000000007401

Cited by 12 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The median age of our cohort was 82 years. Compared with the largest AHF registries, our population was about 10 years older (ADHERE: 73 years 4 and ATTEND: 72 years 10 ), but in line with another retrospective Italian analyses made by Castello et al 11 This finding is likely due to the population aging over the last 10 years and due to a greater control of predisposing factors for HF. We have also to consider that Italy has one of the oldest population in Europe.…”

Section: Discussionsupporting

confidence: 88%

In‐hospital and long‐term mortality for acute heart failure: analysis at the time of admission to the emergency department

et al. 2020

View full text Add to dashboard Cite

Aims Acute heart failure (AHF) leads to a drastic increase in mortality and rehospitalization. The aim of the study was to identify prognostic variables in a real-life population of AHF patients admitted to the emergency department with acute shortness of breath. Methods and results We evaluated potential predictors of mortality in 728 consecutive patients admitted to the emergency department with AHF. Possible predictors of all-cause and cardiovascular (CV) mortality were investigated by Cox and Fine and Gray models at multivariable analysis. Among the 728 patients, 256 died during the entire follow-up, 142 of these due to CV cause. The 1 year mortality rate was 20%, with the highest risk of death during the index hospitalization (with 8% estimate in-hospital mortality at 30 days). A higher risk of events during the index hospitalization was more evident for the CV deaths, for which we found a cumulative 1 year incidence of 12% with a cumulative incidence in the first 30 days of hospitalization of about 5%. At multivariable analysis, age (P < 0.001), New York Heart Association (NYHA) class IV vs. I-II-III (P = 0.001), systolic blood pressure (P < 0.001), non-cardiac co-morbidities (≥3 vs. 0, P = 0.05), oxygen saturation (P = 0.03), serum creatinine (P < 0.001), and left ventricular ejection fraction (LVEF) (40-49% vs. <40%, P = 0.004; ≥50% vs. <40%, P = 0.003) were independent predictors of all-cause mortality during the entire follow-up. Age (P = 0.03), systolic blood pressure (P = 0.01), oxygen saturation (P = 0.03), serum creatinine (P = 0.02), and LVEF (40-49% vs. <40%, P = 0.03; ≥50% vs. <40%, P = 0.004) were independent predictors of CV mortality during the entire follow-up. NYHA class IV vs. I-II-III (P < 0.001), serum creatinine (P = 0.01), and LVEF (40-49% vs. <40%, P = 0.02; ≥50% vs. <40%, P < 0.001) remained independent predictors for in-hospital death, while only serum creatinine (P = 0.04), LVEF (40-49% vs. <40%: 0.32, P = 0.04; ≥50% vs. <40%, P < 0.001), and NYHA class vs. I-II-III (P = 0.02) remained predictors for in-hospital CV mortality. Conclusions In this real-life cohort of patients with AHF, the results showed a similar mortality rate comparing with other analysis and with the most important registries. Age, NYHA class IV, systolic blood pressure, creatinine levels, sodium levels, and ejection fraction were independent predictors of 1 year mortality, while LVEF <40% was the only predictor of both all-cause mortality and CV mortality.

show abstract

Section: Discussionsupporting

confidence: 88%

In‐hospital and long‐term mortality for acute heart failure: analysis at the time of admission to the emergency department

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The usual history of chronic HF is characterized by frequent episodes of acute decompensation (ADHF) needing urgent management in the emergency department (ED), which is then frequently followed by hospitalization (4, 5). Despite some progresses observed in the past decades, the mortality for ADHF remains considerably high, approaching 12% at 30 days after ED assessment (6), with a 30 days re-hospitalization rate as high as 20% (6, 7).…”

Section: Introductionmentioning

confidence: 99%

Red Blood Cell Distribution Width Improves Reclassification of Patients Admitted to the Emergency Department with Acute Decompensated Heart Failure

Turcato¹,

Cervellin²,

Bonora³

et al. 2018

Journal of Medical Biochemistry

View full text Add to dashboard Cite

SummaryBackgroundThe usual history of chronic heart failure (HF) is characterized by frequent episodes of acute decompensation (ADHF), needing urgent management in the emergency department (ED). Since the diagnostic accuracy of routine laboratory tests remains quite limited for predicting short-term mortality in ADHF, this retrospective study investigated the potential significance of combining red blood cell distribution width (RDW) with other conventional tests for prognosticating ADHF upon ED admission.MethodsWe conducted a retrospective study including visits for episodes of ADHF recorded in the ED of the Uni versity Hospital of Verona throughout a 4-year period. Demo - graphic and clinical features were recorded upon patient presentation. All patients were subjected to standard Chest X-ray, electrocardiogram (ECG) and laboratory testing in - cluding creatinine, blood urea nitrogen, B-type natriuretic peptide (BNP), complete blood cell count (CBC), sodium, chloride, potassium and RDW. The 30-day overall mortality after ED presentation was defined as primary endpoint.ResultsThe values of sodium, creatinine, BNP and RDW were higher in patients who died than in those who survived, whilst hypochloremia was more frequent in patients who died than in those who survived. The multivariate model, incorporating these parameters, displayed a modest efficiency for predicting 30-day mortality after ED admission (AUC, 0.701; 95% CI, 0.662-0.738; p=0.001). Notably, the inclusion of RDW in the model significantly enhanced prediction efficiency, with an AUC of 0.723 (95% CI, 0.693-0.763; p<0.001). These results were confirmed with net reclassification improvement (NRI) analysis, showing that combination of RDW with conventional laboratory tests resulted in a much better prediction performance (net reclassification index, 0.222; p=0.001).ConclusionsThe results of our study show that prognostic assessment of ADHF patients in the ED can be significantly improved by combining RDW with other conventional laboratory tests.

show abstract

“…24 Acute decompensation of heart failure is an important determinant of search for emergency departments. 25 , 26 Noncompliance due to pharmacotherapy complexity or the incorrect use of medications can contribute towards acute decompensation of heart failure. 27 Elevated MRCI scores at hospital discharge provide a more general assessment of the risk associated with the complex drug regimen.…”

Section: Discussionmentioning

confidence: 99%

“…24 A descompensação aguda da insuficiência cardíaca é um importante determinante da busca por departamentos de emergência. 25 , 26 A não adesão devido à complexidade da farmacoterapia ou o uso incorreto de medicamentos podem contribuir para a descompensação aguda da insuficiência cardíaca. 27 Escores elevados do MRCI na alta hospitalar fornecem avaliação mais global do risco associado com o regime medicamentoso complexo.…”

Section: Discussionunclassified

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective

Santos¹,

Dias²,

Reis³

2019

Einstein (São Paulo)

View full text Add to dashboard Cite

Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge.Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit.Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023).Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

show abstract

Acute decompensated heart failure in the emergency department

Cited by 12 publications

References 27 publications

In‐hospital and long‐term mortality for acute heart failure: analysis at the time of admission to the emergency department

In‐hospital and long‐term mortality for acute heart failure: analysis at the time of admission to the emergency department

Red Blood Cell Distribution Width Improves Reclassification of Patients Admitted to the Emergency Department with Acute Decompensated Heart Failure

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective

Contact Info

Product

Resources

About