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Current Spanish emergency department organization and clinical practices in caring for patients with acute heart failure

Miró O, Sánchez C, Gil V, Repullo D, García-Lamberechts EJ, González Del Castillo J, Llorens P

√Ārea de Urgencias, Hospital Cl√≠nic, Institut d‚ÄôInvestigacions Biom√®diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Spain. Servicio de Urgencias, Hospital Cl√≠nico San Carlos, Instituto de Investigaci√≥n Sanitaria del Hospital Cl√≠nico San Carlos (IDISSC), Madrid, Spain. Facultad de Medicina, Universidad Complutense de Madrid, Spain. Servicio de Urgencias, Unidad de Estancia Corta y Hospital a Domicilio, Hospital General d‚ÄôAlacant. Instituto de Investigaci√≥n Sanitaria y Biom√©dica de Alicante (ISABIAL), Alicante, Spain. Facultad de Medicina, Universitat Miguel Hern√°ndez, Elx, Alacant, Spain.

Objective. To describe routine diagnostic and therapeutic care processes and assignment of resources available for treating patients with acute heart failure (AHF) in Spanish hospital emergency departments (EDs).
Methods. We surveyed the heads of all hospital EDs in the Spanish national health service concerning their routine diagnostic, therapeutic, and decision-making processes for treating patients with AHF. Questions also covered processes related to continuity of care for patients after discharge. Responses were grouped by hospital size and location (Spanish autonomous community) for comparison.
Results. Heads of 250 of the 282 EDs (89%) responded. Thirty-two percent had a cardiologist on call, and a specialized AHF unit was present in 35%. Such untis were present in more than half the EDs in the Community of Madrid and in Catalonia. Eighty-four percent of EDs measured natriuretic peptide (NP) levels, 80% carried out echocardiographic assessments (although only 24% reported that more than half their staff were trained to undertake echocardiography), and 64% had high-flow nasal cannula (HFNC) systems. Only the Community of Valencia, Navarre, and La Rioja had the capacity for NP analysis, echocardiography, and HFNC therapy in 80% or more of their
hospital EDs. Forty-six percent had admission protocols for patients with AHF, and 60% scheduled outpatient clinic appointments on discharge. Fifty-seven percent of the hospitals with AHF units had consensus-based protocols with their EDs, and 40% of them could schedule clinic appointments from the ED. Large hospitals had significantly better
conditions with respect to some of these aspects of organization and care.
Conclusion. There is room for improvement in the diagnosis and treatment of patients with AHF. We detected opportunities to ensure more effective continuity of care for these patients.

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