Prehospital and in-hospital course of care for patients with acute heart failure: Features and impact on prognosis in "real life".
BACKGROUND
Acute heart failure (AHF) is a life-threatening medical emergency for which no new effective therapies have emerged in recent decades. No previous study has exhaustively described the entire course of care of AHF patients from first medical contact to hospital discharge or assessed its impact on prognosis.


OBJECTIVE
To fully describe the course of care and analyze its influence on outcomes in patients hospitalized with an AHF syndrome in an academic university center.


METHODS
One hundred and nineteen adults with AHF from three public academic university hospitals were consecutively enrolled in a multicenter prospective observational cohort study. All of the emergency departments, intensive care units, coronary care units, cardiology wards and other medical wards participated in the study.


RESULTS
The composite primary outcome (6-month rate of cardiovascular death, readmission for acute heart failure, acute coronary syndrome or stroke) occurred in 59% of patients. This rate was high and similar regardless of first medical contact, type of transport, first medical department of admission and number of medical departments involved in the course of care. A cardiologist was involved in management in 80% of cases. The global median hospital stay was shorter with cardiology vs non-cardiology management (7 days [interquartile range 4-11] vs 10 days [interquartile range 7-18]; P=0.003). History of hypertension (P=0.004), need for non-invasive ventilation (P=0.023) and Lee prognostic score (P=0.028) were independently associated with the primary outcome.


CONCLUSIONS
Morbimortality and readmissions were high regardless of the course of care in patients admitted for AHF in real life. The reduction in hospital stay when cardiologists were involved in management encourages the creation of "mobile AHF cardiology teams".
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Emergency, Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
Laura
L
Cluzol
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
Jennifer
J
Cautela
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Emergency, Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
Pierre
P
Michelet
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Emergency, Nord Hospital, 13915 Marseille cedex 20, France.
Antoine
A
Roch
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), SAMU, 13385 Marseille cedex 5, France.
François
F
Kerbaul
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Public Health (BIOSTIC), Inserm, IRD, UMR 912 SESSTIM, 13273 Marseille, France.
Julien
J
Mancini
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
Marc
M
Laine
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
Michael
M
Peyrol
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
Floriane
F
Robin
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
Franck
F
Paganelli
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
Laurent
L
Bonello
Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unit of Heart Failure and Valvular Heart Disease, Department of Cardiology, Nord Hospital, 13915 Marseille cedex 20, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), Marseille, France. Electronic address: franck.thuny@gmail.com.
Franck
F
Thuny
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends
Acute heart failure; Insuffisance cardiaque aiguë; Mortality; Mortalité; Prognosis; Pronostic