title: Early 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).
abstract: BACKGROUND
  Timing of initial treatment for acute decompensated heart failure (ADHF) varies across hospitals and its impact on outcomes remains poorly defined. We examined the association between time to first intravenous (IV) heart failure (HF) therapy and patient outcomes.
  
  
  METHODS
  Using the ADHERE-EM linked to Medicare claims data, we identified patients ≥65 years old who were hospitalized for ADHF and received IV HF therapy during index admission. Cox proportional hazard model was used to assess the association of time to treatment with a composite of 30-day all-cause mortality or re-admission. Generalized linear mixed models were used to examine the association of time to treatment with in-hospital all-cause mortality, index hospitalization length of stay, and total days alive and out-of-hospital at 30 days.
  
  
  RESULTS
  Of 6,971 patients, the median time to first IV HF therapy was 2.3-hours (interquartile range 1.1, 4.4). The cumulative incidence of 30-day all-cause mortality or readmission was 27.4%. After adjusting for covariates, time to treatment was not associated with increased risk of composite 30-day all-cause mortality or re-admission (HR 1.00; 95% CI 1.00-1.00; P = .221). However, every hour delay in treatment was associated with a modest increased risk of in-hospital mortality (adjusted OR 1.01; 95% CI 1.00-1.02; P = .001) and an approximately 1.4-hour increase in index admission length of stay (P < .001).
  
  
  CONCLUSIONS
  Among older patients presenting with ADHF, delay in initiating IV HF therapy was associated with modestly higher risk for in-hospital mortality and longer length of stay, but was not associated with 30-day outcomes.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27705, USA. yeeweng.wong@duke.edu
authors.forename: Yee Weng
authors.initials: YW
authors.lastname: Wong
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Roger M
authors.initials: RM
authors.lastname: Mills
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Laura G
authors.initials: LG
authors.lastname: Qualls
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D004232:Diuretics / Q000008:administration & dosage; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D004232:Diuretics; D014665:Vasodilator Agents