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Vol. 224. Issue 4.
Pages 204-216 (April 2024)
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Vol. 224. Issue 4.
Pages 204-216 (April 2024)
Original article
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
Aspectos epidemiológicos, manejo clínico y resultados a corto plazo en pacientes mayores diagnosticados de insuficiencia cardiaca aguda en urgencias en España: resultados del estudio EDEN-34
Ò. Miróa, P. Llorensb,
Corresponding author
llorens_ped@gva.es

Corresponding author.
, S. Aguilóa, A. Alquézar-Arbéc, C. Fernándezd, G. Burillo-Putzee, N.C. Marcosa, A.A. Marañóna, G.S. Omsa, J.G. del Castillod, SIESTA* (Spanish Investigators in Emergency Situations TeAm) 1
a Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
b Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
c Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
d Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
e Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain
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Tables (3)
Table 1. Analysis of the characteristics of patients diagnosed with acute heart failure in the emergency department in the EDEN-34 study and comparative analysis based on destination after emergency department care (discharge/hospitalization) and whether the diagnosis was confirmed or not in the hospitalized patient.
Table 2. Multivariate analysis that explores the independent factors associated with adverse events in patients diagnosed with heart failure in the emergency department. Odds ratios are shown in decreasing order.
Table 3. Comparison between findings in EDEN-34, EAHFE registry, and the RICA registry for certain variables in patients with acute heart failure.
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Abstract
Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Acute heart failure
Geriatrics
Severity
Mortality
Hospitalization
Resumen
Objetivo

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.

Método

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.

Resultados

Se incluyeron 1.155 pacientes con ICA (incidencia anual: 26,5 por 1000 habitantes ≥65 años, IC95%: 25,0-28,1). En el 86% el diagnóstico de ICA constaba al alta. La mortalidad global a 30 días fue del 10,7%, la intrahospitalaria del 7,9% y el evento combinado postalta un 15,6%. La mortalidad intrahospitalaria y a 30 días se asoció con hipotensión arterial (OR ajustada: 74.0, 95% CI: 5,39-1015.; y 42,6, 3,74-485, respectivamente) e hipoxemia (2,14, 1,27-3,61; y 1,87, 1,19-2,93) a la llegada a urgencias y con precisar ayuda en la deambulación (2,24, 1,04-4,83; y 2,48, 1,27-4,86) y la edad (por cada incremento de 10 años; 1,54, 1,04-2,29, y 1,60, 1,13-2,28).

Conclusiones

La ICA es un diagnóstico frecuente en los pacientes mayores que consultan en los SU. El deterioro funcional, la edad, la hipotensión e hipoxemia son los factores que más se asocian a mortalidad.

Palabras clave:
Insuficiencia cardiaca aguda
Geriatría
Gravedad
Mortalidad
Hospitalización
Urgencias

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