Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España.
Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España.
Emergencias. 2021 Jun;33(3):165-173.
To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas.
Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge.
We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%).
Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis.
研究高风险标准对从急诊科（ED）或 ED 观察和短期留观区出院的虚弱老年急性心力衰竭（AHF）患者 30 天结局的影响。
对 Older AHF Key Data 注册登记处的出院记录进行二次分析。我们选择了从 ED 出院的年龄＞70 岁的虚弱患者（AHF）。将危险因素分为可改变和不可改变。结局是 30 天内心血管事件的复合终点（HF 再住院、HF 住院或心血管死亡）和出院后 30 天内院外生存天数（DAOH）。
共纳入 380 例平均（SD）年龄为 86（5.5）岁（61.2%为女性）的患者。可改变的危险因素占 65.1%，不可改变的占 47.8%，两者都有的占 81.6%。83 例患者（21.8%）发生 30 天心血管复合终点事件。观察到的 30 天 DAOH 平均值为 27.6（6.1）天。高风险因素在发生心血管事件复合终点的患者中更为常见：与低风险患者相比，具有可改变、不可改变或两者均有的风险因素的患者发生率分别为：25.0%比 17.2%，P=.092；27.6%比 16.7%，P=.010；24.7%比 15.2%，P=.098）。根据存在的风险因素类型，高危患者的 30 天 DAOH 结局也较低：可改变因素为 26.9（7.0）比 28.4（4.4）天，P=.011；不可改变因素为 27.1（7.0）比 28.0（5.0）天，P=.127；两者均为 27.1（6.7）比 28.8（3.4）天，P=.005）。多变量分析后，可改变的风险因素与存活天数减少独立相关（30 天 DAOH 的调整绝对差异，-1.3 天[95%CI，-2.7 至-0.1 天]）。不可改变的因素与 30 天心血管复合终点事件的风险增加相关（调整绝对差异，10.4%；95%CI，-2.1%至 18.7%）。
从医院 ED 区域出院的虚弱老年 AHF 患者中常见风险因素。它们的存在与较差的 30 天预后相关。
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