Management of acute heart failure in spanish emergency departments based on age.
OBJECTIVE
To investigate possible age-related differences in the profile, clinical symptoms, management, and short-term outcomes of patients seen for acute heart failure in Spanish emergency departments.


METHODS
We performed a multipurpose, multicenter study with prospective follow-up including all patients with acute heart failure attended in 29 Spanish emergency departments. The following variables were collected: demographic, personal history, geriatric syndromes, data of acute episode, discharge destination, in-hospital and 30-day mortality and 30-day revisit. The sample was divided into 4 age groups: <65, 65-74, 75-84, and ≥85 years.


RESULTS
We included 5819 patients: 493 (8.5%) were <65 years old, 971 (16.7%) were 65-74 years old, 2407 (41.4%) were 75-84 years old, and 1948 (33.5%) were ≥85 years old; 4424 patients (76.5%) were admitted from the emergency department, 251 of whom (4.5%) died during hospitalization. Statistically significant differences were observed in relation to cardiovascular risk factors, comorbidities, geriatric syndromes, clinical presentation, and diagnostic and therapeutic procedures based on an increase in the age of the groups. A statistically significant linear trend was observed between age group and the probability of hospital admission (P<.001), and hospital (P<.001) and 30-day mortality (P<.001).


CONCLUSIONS
The management of acute heart failure in elderly patients requires a multidimensional approach which goes beyond merely cardiological aspects of treatment.
Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain. Electronic address: fjjms@hotmail.com.
Francisco Javier
FJ
Martín-Sánchez
Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Rocío
R
Marino-Genicio
Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
Esther
E
Rodríguez-Adrada
Servicio de Urgencias, Hospital Universitari de Bellvitge IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Javier
J
Jacob
Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Pablo
P
Herrero
Área de Urgencias, Hospital Clínic, Barcelona, Spain; Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain.
Oscar
O
Miró
Servicio de Urgencias-UCE y UHD, Hospital General Universitario de Alicante, Alicante, Spain.
Pere
P
Llorens
Departamento de Geriatría, Universidad Complutense, Hospital Clínico San Carlos, Madrid, Spain.
José Manuel
JM
Ribera-Casado
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013030:Spain
AHF; Acute heart failure; Anciano; ED; Elderly; Emergency department; HF; Insuficiencia cardiaca aguda; Servicio de urgencias; acute heart failure; emergency departments; heart failure