title: Characteristics and outcomes for acute heart failure in elderly patients presenting to the ED.
abstract: BACKGROUND
  The first aim of this study was to investigate the characteristics for elderly patients with acute heart failure presenting to the emergency department (ED). The second aim was to determine the characteristics of these elderly patients associated with serious adverse events.
  
  
  METHODS
  The population was divided into 2 age groups, <80 and ≥80 years. The primary outcome was the occurrence of a serious adverse event, defined as either death from any cause within 30 days of the index ED visit or any of the following events within 14 days of the index ED visit: admission to a monitored unit, intubation, need for noninvasive ventilation, myocardial infarction, major procedure, or, for patients who were discharged after the initial visit, return to the ED resulting in admission to hospital.
  
  
  RESULTS
  This prospective cohort study included 1658 visits. Older patients had a lower heart rate and higher diastolic blood pressure. The older patients were more likely to experience hospital admission (56% vs 46%, P < .001). For patients 80 years or older, 109 (14%) experienced a serious adverse event. In this ≥80-year group, history of heart failure, current medication with antiarrhythmic, acute infarction on the arrival electrocardiography, chest x-ray with pleural effusion, and urea greater than 12 mmol/L were independently associated with short-term serious adverse events.
  
  
  CONCLUSIONS
  Elderly patients with heart failure are a high-risk group. Careful assessment of these factors could help physicians identify those patients most at risk for adverse outcomes and, therefore, most in need of hospital admission.
authors: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, Nîmes, France; EA 2415, Clinical Research University Institute, Montpellier University, Montpellier, France; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: pierre.geraud.claret@gmail.com.
authors: Pierre-Géraud
authors: PG
authors: Claret
authors: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: istiell@ohri.ca.
authors: Ian G
authors: IG
authors: Stiell
authors: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, The University of Western Ontario, London, Ontario, Canada; Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada. Electronic address: jyan2009@meds.uwo.ca.
authors: Justin W
authors: JW
authors: Yan
authors: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: cclement@ohri.ca.
authors: Catherine M
authors: CM
authors: Clement
authors: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: brian.rowe@ualberta.ca.
authors: Brian H
authors: BH
authors: Rowe
authors: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: lcalder@toh.on.ca.
authors: Lisa A
authors: LA
authors: Calder
authors: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: jperry@ohri.ca.
authors: Jeffrey J
authors: JJ
authors: Perry
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001794:Blood Pressure; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D063087:Noninvasive Ventilation; D010343:Patient Admission; D010359:Patient Readmission; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011446:Prospective Studies; D014508:Urea / Q000097:blood
chemical_list: D000889:Anti-Arrhythmia Agents; D014508:Urea