The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

BMC Emergency Medicine

On Behalf of the EURODEM Study Group¹  Tuukka Tarvasmäki²  Franck Verschuren³  Luis Garcia-Castrillo⁴  Michael Christ⁴  Jean Capsec⁵  Richard Body⁶  Òscar Miró⁷  Mehmet A. Karamercan⁸  Ari Palomäki⁹  Adela Golea^1,10  Pia Harjola^1,11  Veli-Pekka Harjola^1,11  Jukka Tolonen^1,12  Oene van Meer^1,13  Paul-Louis Martin^1,14  Said Laribi^1,14  Cinzia Barletta^1,15 

[1] ;Cardiology, University of Helsinki and Heart and Lung Cent, Helsinki University Hospital;Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc;Department of Emergency Care, Luzerner Kantonsspital;Department of Public Health, Centre Hospitalier Régional Universitaire de Tours;Division of Cardiovascular Sciences, The University of Manchester;Emergency Department, Hospital Clínic, University of Barcelona;Emergency Medicine Department, Faculty of Medicine, Gazi University;Emergency Medicine, Campus of Tampere, Kanta-Häme Central Hospital;Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy;Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital;Internal Medicine, University of Helsinki and Department of Medicine, Helsinki University Hospital;Leiden University Medical Center;School of Medicine and CHU Tours, Emergency Medicine Department, Tours University;Servicio Urgencias Hospital Marqués de Valdecilla;

关键词: Acute heart failure;    Arrival mode;    Management;    Prognosis;    Emergency medical services;    Ventilatory support;   

DOI  :  10.1186/s12873-022-00574-z

来源: DOAJ

【 摘 要 】

Abstract Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.

【 授权许可】

Unknown