Decompensated heart failure in the emergency department of a cardiology hospital.
BACKGROUND
National studies on decompensated heart failure (DHF) are key to the understanding of this condition in our midst.


OBJECTIVE
To determine the characteristics of DHF patients in an emergency department.


METHODS
A total of 212 patients diagnosed with decompensated heart failure who had been admitted to an emergency department (EU) of a cardiology hospital were prospectively evaluated. Clinical variables, form of presentation and causes of decompensation were studied. In 100 patients, ancillary tests, prescription of vasoactive drugs, length of hospital stay and mortality were also analyzed.


RESULTS
There was a predominance of the male gender (56%) and the most frequent etiology was ischemia (29,7%) despite high frequency of valvular (15%) and chagasic (14,7%) etiologies. The most common form of presentation and cause of decompensation were congestion (80.7%) and poor compliance/inadequate medication (43.4%), respectively. In the subanalysis of the 100 patients, systolic dysfunction was the most common cause of decompensation (55%); use of vasoactive drugs occurred in 20%, and mortality was 10%. The comparative analysis between the patients who were discharged and those who died during hospitalization confirmed some criteria of poor prognosis: reduced systolic blood pressure, low cardiac output associated with congestion, need for vasoactive drugs, reduced left ventricular ejection fraction, increased left ventricular diastolic diameter (LVDD) and hyponatremia.


CONCLUSIONS
This study presents information about the profile of decompensated heart failure patients attended on the emergency unit of a brazilian southeast cardiology hospital. Clinical, hemodynamical and ancillary data may provide information for risk assessment in the initial evaluation helping the decision on hospitalization and advanced strategic therapies.
Mangini
Sandrigo
S
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil. sandrigomangini@cardiol.br
Silveira
Fábio Serra
FS
Silva
Christiano Pereira
CP
Grativvol
Petherson Suzano
PS
Seguro
Luís Fernando Bernal da Costa
LF
Ferreira
Sílvia Moreira Ayub
SM
Mocelin
Amílcar Oshiro
AO
Cardoso
Luiz Francisco
LF
Bacal
Fernando
F
Bocchi
Edimar Alcides
EA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001938:Brazil / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D002316:Cardiotonic Agents; D004280:Dobutamine; D004298:Dopamine