Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
School of Medicine, Bond University, Gold Coast, Queensland, Australia.
BMJ Open. 2017 Feb 28;7(2):e013812. doi: 10.1136/bmjopen-2016-013812.
To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea.
Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM).
46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014.
Patients with an ED diagnosis of heart failure.
Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality).
455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4-9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled β-agonists (13%) and corticosteroids (6%).
In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.
描述以呼吸困难为主要症状就诊于急诊科的患者被诊断为心力衰竭后的人口统计学特征、评估、管理和结局。
前瞻性描述性队列研究的计划子研究：亚洲、澳大利亚和新西兰急诊科呼吸困难研究（AANZDEM）。
2014 年 5 月、8 月和 10 月，澳大利亚、新西兰、新加坡、中国香港和马来西亚的 46 家急诊科在 3 个 72 小时期间收集数据。
急诊科诊断为心力衰竭的患者。
结局包括患者流行病学、所开检查、所使用的治疗方式和患者结局（住院时间长短和死亡率）。
在 3044 例患者中，有 455 例（14.9%）被急诊科诊断为心力衰竭。中位年龄为 79 岁，一半为男性，62%通过救护车到达。392 例（86%）患者被收入住院。急诊科诊断与出院诊断相符的比例为 81%。中位住院时间为 6 天（四分位距 4-9），院内死亡率为 5.1%。19%的患者进行了利钠肽水平检测，很少进行肺部超声（<1%）和超声心动图（2%）检查。治疗方式包括无创通气（12%）、利尿剂（73%）、硝酸盐（25%）、抗生素（16%）、吸入β-激动剂（13%）和皮质激素（6%）。
在亚太地区，以呼吸困难为主要症状就诊于急诊科的患者心力衰竭的常见诊断。住院率较高，急诊科诊断准确性较好。尽管对检查和治疗指南的依从性似乎不理想，但与其他登记处相比，患者结局较好。
