title: Association between prehospital time interval and short-term outcome in acute heart failure patients.
abstract: BACKGROUND
  Acute heart failure (AHF) is one of the most frequently encountered cardiovascular conditions that can seriously affect the patient's prognosis. However, the importance of early triage and treatment initiation in the setting of AHF has not been recognized.
  
  
  RESULTS
  The Tokyo Cardiac Care Unit Network Database prospectively collected information of emergency admissions to acute cardiac care facilities in 2005-2007 from 67 participating hospitals in the Tokyo metropolitan area. We analyzed records of 1,218 AHF patients transported to medical centers via emergency medical services (EMS). AHF was defined as rapid onset or change in the signs and symptoms of heart failure, resulting in the need for urgent therapy. Patients with acute coronary syndrome were excluded from this analysis. Logistic regression analysis was performed to calculate the risk-adjusted in-hospital mortality. A majority of the patients were elderly (76.1 ± 11.5 years old) and male (54.1%). The overall in-hospital mortality rate was 6.0%. The median time interval between symptom onset and EMS arrival (response time) was 64 minutes (interquartile range [IQR] 26-205 minutes), and that between EMS arrival and ER arrival (transportation time) was 27 minutes (IQR 9-78 minutes). The risk-adjusted mortality increased with transportation time, but did not correlate with the response time. Those who took >45 minutes to arrive at the medical centers were at a higher risk for in-hospital mortality (odds ratio 2.24, 95% confidence interval 1.17-4.31; P = .015).
  
  
  CONCLUSIONS
  Transportation time correlated with risk-adjusted mortality, and steps should be taken to reduce the EMS transfer time to improve the outcome in AHF patients.
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takahashi
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Atsutoshi
authors.initials: A
authors.lastname: Takagi
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Harada
authors.forename: Takamichi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sakai
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome