Resumen

< Return

Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial




Mart√≠n-S√°nchez FJ, Parra Esquivel P, Llopis Garc√≠a G, Gonz√°lez Del Castillo J, Rodr√≠guez Adrada E, Espinosa B, L√≥pez D√≠ez MP, Romero Pareja R, Rizzi Bordigoni MA, P√©rez-Dur√° MJ, Bibiano C, Ferrer C, Aguil√≥ S, Mart√≠n Mojarro E, Aguirre A, Pi√Īera P, L√≥pez-Picado A, Llorens P, Jacob J, Gil V, Herrero P, Fern√°ndez P√©rez C, Gil P, Calvo E, Rossell√≥ X, Bueno H, Burillo G, Mir√≥ O



Servicio de Urgencias, Hospital Universitario Cl√≠nico San Carlos, Instituto de Investigaci√≥n Sanitaria del Hospital Cl√≠nico San Carlos (IdISSC), Madrid, Spain. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain. Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain. Servicio de Urgencias, Hospital Rey Juan Carlos, M√≥stoles, Madrid, Spain. 5Servicio de Urgencias, Unidad de Corta Estancia y Hospitalizaci√≥n a Domicilio, Hospital General de Alicante, Instituto de Investigaci√≥n Sanitaria y Biom√©dica de Alicante (ISABIAL-Fundaci√≥n FISABIO), Spain. Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Burgos, Burgos, Spain. Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Unidad de Corta Estancia, Hospital La Fe, Valencia, Spain. Servicio de Urgencias, Hospital Universitario Infanta Leonor, Vallecas, Madrid, Spain. Servicio de Urgencias, Hospital Universitario de Bellvitge, L‚ÄôHospitalet de Llobregat, Barcelona, Spain. √Ārea de Urgencias, Hospital Cl√≠nic, Barcelona, Grupo de Investigaci√≥n ‚ÄúUrgencias: Procesos y Patolog√≠as‚ÄĚ, IDIBAPS, Barcelona, Spain. Servicio de Urgencias, Hospital de Santa Tecla, Tarragona, Spain. Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. Servicio de Urgencias, Hospital Reina Sof√≠a, Murcia, Spain. Unidad de Investigaci√≥n Cl√≠nica y Ensayos Cl√≠nicos, Hospital Cl√≠nico San Carlos, Instituto de Investigaci√≥n Sanitaria del Hospital Cl√≠nico San Carlos (IdISSC), Madrid, Spain. Servicio de Medicina Preventiva, Hospital Cl√≠nico San Carlos; Instituto de Investigaci√≥n Sanitaria del Hospital Cl√≠nico San Carlos (IdISSC), Facultad de Enfermer√≠a, Universidad de Enfermer√≠a, Madrid, Spain. Servicio de Geriatr√≠a, Hospital Cl√≠nico San Carlos; Instituto de Investigaci√≥n Sanitaria del Hospital Cl√≠nico San Carlos (IdISSC), Madrid, Spain. Servicio de Medicina Interna, Hospital Cl√≠nico San Carlos, Instituto de Investigaci√≥n Sanitaria del Hospital Cl√≠nico San Carlos (IdISSC), Spain. Servicio de Cardiolog√≠a, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain. Servicio de Cardiolog√≠a, Hospital Universitario 12 de Octubre, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain...



Objectives. 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.
Methods. 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.
Results. 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, ‚Äď1.3 days (95% CI, ‚Äď2.7 to ‚Äď0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, ‚Äď2.1% to 18.7%).
Conclusion. 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.


Síguenos en:

Search the Journal




* Search for article from 1988 to present (from volume 1, number 0, 1988)