Acute heart failure in the emergency department: a follow-up study.
Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients' mean age was 84, with 66.0% over 80 years and 56.2% females. Comorbidities were present in over 50% of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6 h in 24 cases (1.9%). At 30-day follow-up, death was registered in 123 cases (10.0%): 110 cases (89.4%) died of cardiovascular events and 13 (10.6%) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1% (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure <110 mm/Hg, high NT pro-BNP, high troponin levels and impaired cognitive status) were selected as outcome predictors, but with limited discriminant capacity (AUC = 0.649; SE 0.015). Recurrence of AHF was registered in 31.0%. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis.
Department of Emergency Medicine, Presidio Ospedaliero Morgagni-Pierantonio, AUSL della Romagna - Forlì, Via Forlanini 34, 47121, Forlì, Italy. andrea.fabbri@auslromagna.it.
Andrea
A
Fabbri
Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S. Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy.
Giulio
G
Marchesini
Department of Emergency Medicine, Gradenigo Hospital, Corso Regina Margherita 8/10, 10100, Torino, Italy.
Giorgio
G
Carbone
Department of Emergency Medicine, Osp. Maggiore Policlinico, fondazione Cà Granda, via F. Sforza 35, 20122, Milan, Italy.
Roberto
R
Cosentini
Department of Emergency Medicine, Ospedale S. Maria Nuova, via Risorgimento 80, 4100, Reggio Emilia, Italy.
Annamaria
A
Ferrari
Department of Emergency Medicine, Ospedale S. Antonio, Azienda Ospedaliera, via Facciolati 71, 36124, Padua, Italy.
Mauro
M
Chiesa
Department of Emergency Medicine, Azienda Ospedaliera Universitaria Pisana, via Roma 67, 56126, Pisa, Italy.
Alessio
A
Bertini
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, via Bicocca degli Arcimboldi 8, 20126, Milan, Italy.
Federico
F
Rea
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors
Acute heart failure; Clinical characteristics; Emergency department; Epidemiology; Follow-up