Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain.
Clin Res Cardiol. 2018 Apr;107(4):347-361. doi: 10.1007/s00392-017-1190-2. Epub 2017 Dec 28.
Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs).
We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups.
We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115-2.811; p = 0.016), and 1.939 (95% CI 1.114-3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance.
Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
对于在院前阶段接受高级生命支持（ALS）救护车团队治疗的急性心力衰竭（AHF）患者，我们对其接受的治疗以及对短期预后的影响知之甚少。我们评估了西班牙急诊科（ED）连续诊断为 AHF 的患者的院前护理效果。
我们从 EAHFE 登记处中选择了由 ALS 救护车送达 ED 的患者，这些患者有可用的随访数据。我们记录了特定的院前 ALS 治疗（补充氧气、利尿剂、硝酸甘油、无创通气），并根据患者是否接受低强度（LIPHT；0/1 种治疗）或高强度院前治疗（HIPHT；>1 种治疗）对 AHF 进行分组。我们还记录了 46 个协变量。主要终点是全因 7 天死亡率，次要终点是延长住院时间（>10 天）和住院期间及 30 天死亡率。计算未调整和调整后的优势比以比较两组。
我们纳入了 1493 名患者[平均年龄 80.7（10）岁；女性占 54.8%]。院前治疗包括补充氧气（71.2%）、利尿剂（27.9%）、硝酸甘油（13.5%）和无创通气（5.3%）。LIPHT 组包括 1041 名患者（70.0%），未调整的 7 天死亡率优势比为 1.770（95%CI 1.115-2.811；p=0.016），调整了 16 个不一致的协变量后为 1.939（95%CI 1.114-3.287，p=0.014）。在 LIPHT 组中，所有次要终点的调整后优势比始终大于 1，但均无统计学意义。
最终在 ED 被诊断为 AHF 且由 ALS 救护车团队接受 LIPHT 治疗的患者短期预后较差，尤其是在最初的 7 天内。
