Clinical InvestigationHeart FailureEarly intravenous heart failure therapy and outcomes among older patients hospitalized for acute decompensated heart failure: Findings from the Acute Decompensated Heart Failure Registry Emergency Module (ADHERE-EM)
Section snippets
Background
The majority of acute decompensated heart failure (ADHF) patients present initially to the emergency department (ED) and the time to treatment varies across hospitals.1, 2 Similar to efforts focused on myocardial infarction, the timing of initial emergency management of patients with ADHF may be important for early outcomes.2 Most patients hospitalized with ADHF receive intravenous (IV) heart failure (HF) therapy, such as diuretics and vasoactive medications, but the relationship between time
Data sources
This study was performed using data from the ADHERE-EM registry and the United States Centers for Medicare and Medicaid Services. Detailed descriptions of the ADHERE and ADHERE-EM registries have been published previously.7, 8 In brief, patients were eligible for the ADHERE registry if they were ≥18 years old and were hospitalized with a primary or secondary discharge diagnosis of HF. The ADHERE-EM registry required that patients present to the ED with suspected ADHF and collected additional
Patient characteristics
Among the 17,614 patients in the ADHERE-EM registry, 6,971 patients were included in the primary analysis cohort based on pre-specified criteria (Figure 1). The median time to treatment was 2.3 hours (IQR 1.1, 4.4) with mean time to treatment of 5.2 hours (SD 12.2 hours). The majority (72%) of patients received the first IV HF therapy within the first 4 hours of hospital presentation. Baseline characteristics and acute management are summarized in Table I. Patients in the first quartile of time
Discussion
This study is one of the largest to examine timing of IV HF therapy and 30 day outcomes for ADHF patients presenting to the ED. Key findings are that the majority of patients presenting with ADHF received the first IV HF therapy relatively promptly and patients with the shortest time to treatment were more likely to exhibit clinical signs of congestion. In addition, delay in treatment was associated with a modestly higher risk of in-hospital adverse clinical outcomes, but not 30-day adverse
Conclusion
Among patients 65 years and older who present to the ED with ADHF, the majority of patients are likely to be treated with an IV HF therapy within 4 hours of hospital presentation. Although longer time to earliest IV HF therapy is associated with increased risk of in-hospital mortality and hospital LOS, the association is modest. Limited delay in initiating current standard IV HF therapy does not appear to significantly influence patient outcomes at 30 days.
Disclosures
YWW, XJM, LGQ: None declared.
GCF: Consulting fees/Honoraria: Novartis, Gambro, Johnson & Johnson, Medtronic, Boston Scientific, Medicines Company, NCDR; Research grants: NHLBI, NIH/NIAID, Novartis.
WFP: Research grants: Abbott, Alere, Brahms, Novartis, Roche, The Medicine’s Company; Consultant: Abbott, Alere, BG, Cardiorentis, GE, Jannsen, Lily, The Medicine’s Company, Singulex, Verathon; Speaker’s Bureau: Abbott, Alere, Astra-Zeneca, Daichi-Sankyo; Ownership Interest: Comprehensive Research
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Hector O. Ventura, MD served as guest editor for this article.