Impact of early initiation of intravenous therapy for acute decompensated heart failure on outcomes in ADHERE.
BACKGROUND
Since most acute decompensated heart failure (ADHF) patients present for hospital care via the emergency department (ED), we sought to determine the impact of early ED initiation of ADHF-specific therapy, as indicated by nesiritide use, on subsequent outcomes.


METHODS
We queried the Acute Decompensated Heart Failure National Registry (ADHERE) to identify patients with initial systolic blood pressure >90 mm Hg and negative cardiac biomarkers, hospitalized after presentation to the ED, who received nesiritide but no other intravenous vasoactive drugs. Intensive care unit use and total hospital length of stay were compared based on the hospital unit where nesiritide therapy was initiated after multivariate adjustment for baseline differences in study populations.


RESULTS
Nesiritide was started in the ED in 1,613 patients (EDN group) and after admission to an inpatient unit in 2,687 patients (INN group). EDN patients had higher baseline systolic and diastolic blood pressure (both p < 0.001); while INN patients were more likely to be male and have baseline renal dysfunction (both p < 0.001). Nesiritide was initiated a median of 2.8 and 15.5 h after presentation in EDN and INN patients, respectively (p < 0.001). Compared to INN, EDN patients had a shorter adjusted mean total hospital length of stay (5.4 vs. 6.9 days; p < 0.001), were less likely to require transfer to the intensive care unit from another inpatient unit (odds ratio [OR]: 0.301; 95% confidence interval [CI]: 0.206-0.440), and were more likely to be discharged home (OR: 1.154; 95% CI: 1.005-1.325).


CONCLUSIONS
Initiation of ADHF-specific therapy early, while the patient is in the ED, is associated with improved clinical outcomes.
Peacock
W Frank
WF
Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195 , USA. Peacocw@ccf.org
Fonarow
Gregg C
GC
Emerman
Charles L
CL
Mills
Roger M
RM
Wynne
Janet
J
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D045283:Natriuretic Agents / Q000008:administration & dosage*; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D012042:Registries; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain