Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study

To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed...

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Veröffentlicht in:Revista clínica espanõla (English edition) 2024-04, Vol.224 (4), p.204-216
Hauptverfasser: Miró, Ò., Llorens, P., Aguiló, S., Alquézar-Arbé, A., Fernández, C., Burillo-Putze, G., Marcos, N.C., Marañón, A.A., Oms, G.S., del Castillo, J.G.
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Sprache:eng
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Zusammenfassung:To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0–28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39–1015. and 42.6, 3.74–485, respectively and hypoxemia (2.14, 1.27–3.61; and 1.87, 1.19–2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04–4.83; and 2.48, 1.27–4.86) and age (per 10-year increment; 1.54, 1.04–2.29; and 1.60, 1.13–2.28). The combined post-discharge adverse event was not associated with any characteristic. AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality. Estimar la incidencia de diagnóstico de insuficiencia cardiaca aguda (ICA) en pacientes mayores en los servicios de urgencias (SU), la confirmación diagnóstica de la ICA en pacientes hospitalizados y los eventos adversos a corto plazo. Se incluyeron todos los pacientes de ≥65 años atendidos en 52 SU españoles durante 1 semana y se seleccionaron los diagnosticados de ICA. En los hospitalizados, se recogieron los diagnosticados de ICA al alta. Como eventos adversos, se recogió la mortalidad intrahospitalaria y a 30 días, y evento adverso combinado (muerte u hospitalización) a 30 días posalta. Se calcularon las odds ratio (OR) ajustadas de las características demográficas, de estado basal y a la llegada al SU asociadas con mortalidad y evento adverso posalta a 30 días. Se incluyeron 1.155 pacientes con ICA (incidencia anual: 26,5 por 1000 habitantes ≥65
ISSN:2254-8874
2254-8874
DOI:10.1016/j.rceng.2024.02.014