Acute heart failure registry from high-volume university hospital ED: comparing European and US data

Jiri Karasek, Petr Widimsky, Petr Ostadal, Hana Hrabakova, Martin Penicka
American Journal of Emergency Medicine 2012, 30 (5): 695-705

BACKGROUND: Acute heart failure (AHF) is associated with a poor prognosis.

OBJECTIVES: The objectives of this study are to describe mechanisms of AHF and to identify the predictors for all-cause mortality by patients admitted for hospitalization by emergency departments (EDs) as well as to compare European and American data.

METHODS: We designed a prospective registry of consecutively admitted patients for AHF to a high-volume university hospital ED during a 1-year period (n=202; age, 75±11 years; 51% men; ejection fraction, 38%±15%).

RESULTS: The major causes of AHF were coronary artery disease, often with concomitant mitral regurgitation, hypertension, or atrial fibrillation (>90% of cases). At admission, 24.9% of patients had preserved ejection fractions (>50%); and only 7.7% fulfilled the definition of diastolic AHF. The 30-day and long-term mortality (median follow-up, 793 days) were 20.3% and 31.0%, respectively. A low systolic blood pressure (P=.006), reduced ejection fraction (P=.044), and low serum hemoglobin level (P<.01) emerged as the strongest predictors of all-cause mortality. In patients with AHF without acute myocardial infarction (MI) (63.9%), prescription, at discharge, of statins (P<.05) was independently associated with all-cause mortality.

CONCLUSIONS: The patient's blood pressure, ejection fraction, and hemoglobin values, at admission, were identified as the strongest predictors of all-cause mortality. In AHF not triggered by acute MI, long-term use of statins may be associated with reduced survival. The prevalence of diastolic AHF is low. The American AHF population had similar baseline characteristics; needed fewer intensive care unit admissions; had a better 30 days of prognosis, lower incidence of MI, and de novo AHF diagnoses. In a similar subgroup, we observed similar incidences of inotropic support and mechanical ventilation. Our results could not be generalized to all patients with AHF admitted to US EDs.


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