Abstract 18737: Door-to-Furosemide Time is Associated With In-Hospital Mortality in Acute Heart Failure Patients: Insights From REALITY-AHF

IntroductionAlthough early management strategy in emergency department (ED) is recommended for acute heart failure (AHF) patients, there is no prospective data regarding its prognostic impact.HypothesisDoor-to-furosemide time is associated with in-hospital mortality.MethodsThe REALITY-AHF is a prospective, multicenter cohort study which focused on super-acute phase management of patients with AHF. 1787 Consecutive patients hospitalized for AHF through ED in 19 hospitals have been enrolled from October 2014 to December 2015. Time from ED arrival to first intravenous furosemide was recorded as “door-to-furosemide”, and ≤60 minutes was defined as early treatment. Outcome was all-cause in-hospital mortality.Results1334 patients [median age, 80 (IQR, 71-87); 55% were males] were treated with intravenous furosemide within 48 hours from ED arrival, and were included for analysis. Median time-to-furosemide was 92 minutes (IQR37-200), and 497 patients (37%) were categorized into early treatment group. In-hospital mortality was 5.0% for all cohort, and significantly lower in early treatment group compared to non-early treatment group (2.2% vs 6.6%, P=0.001). In-hospital mortality subsequently increased as the time-to-furosemide increased, especially in the first 120 minutes from ED arrival. Early-treatment group was an independently associated with low in-hospital mortality even after adjustment for other prognostic factors (Odds ratio0.38, 95% CI0.19-0.75, P=0.005).ConclusionsThe “door-to-furosemide” is associated with short-term mortality. This results provide scientific basis for early treatment strategy in AHF patients.