Miró Òscar, Gil Víctor, Xipell Carolina, Sánchez Carolina, Aguiló Sira, Martín-Sánchez Francisco J, Herrero Pablo, Jacob Javier, Mebazaa Alexandre, Harjola Veli-Pekka, Llorens Pere
Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
"Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
Clin Res Cardiol. 2017 May;106(5):369-378. doi: 10.1007/s00392-016-1065-y. Epub 2016 Dec 22.
To define the short- and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization.
We performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four 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 all-cause 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 hospitalization.
Of the 3233 patients diagnosed with ADHF during a 2-month period, we analyzed 2986 patients discharged alive: 787 (26.4%) discharged from the ED and 2199 (73.6%) after hospitalization. The cumulative percentages of events for the whole cohort (at 7/30/180 days) for the combined endpoint were 7.8/24.7/57.8; for ED revisit 2.5/9.4/25.5; for hospitalization 4.6/15.3/40.7; and for death 0.9/4.3/16.8. After adjustment for patient profile and center, significant increases were found in the hazard ratios for ED- compared to hospital-discharged patients in the combined endpoint, ED revisit and hospitalization, being higher at short-term [at 7 days, 2.373 (1.678-3.355), 2.069 (1.188-3.602), and 3.071 (1.915-4.922), respectively] than at mid-term [at 180 days, 1.368 (1.160-1.614), 1.642 (1.265-2.132), and 1.302 (1.044-1.623), respectively]. No significant differences were found in death.
Patients 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 needed.
明确急性失代偿性心力衰竭（ADHF）发作后出院患者的短期和中期结局，并评估直接从急诊科（ED）出院的患者与住院后出院的患者之间的差异。
我们进行了一项前瞻性、多中心、队列设计研究，纳入了西班牙27家急诊科连续诊断为ADHF的患者。收集了每位患者关于流行病学、合并症、基线状态、生命体征、充血体征、实验室检查和治疗的34项变量。主要结局是ED复诊（未住院）或因ADHF住院或全因死亡的复合终点。次要结局是这三个事件中的每一个单独事件。通过对整个队列在不同时间点的生存分析获得结局，并对直接从ED出院的患者和住院后出院的患者进行了粗率和校正比较。
在2个月期间诊断为ADHF的3233例患者中，我们分析了2986例存活出院的患者：787例（26.4%）从ED出院，2199例（73.6%）住院后出院。整个队列（在7/30/180天）复合终点事件的累积百分比分别为7.8/24.7/57.8；ED复诊为2.5/9.4/25.5；住院为4.6/15.3/40.7；死亡为0.9/4.3/16.8。在对患者特征和中心进行校正后，发现与住院后出院的患者相比，ED出院患者在复合终点、ED复诊和住院方面的风险比显著增加，短期（7天）时更高[分别为2.373（1.678 - 3.
