title: Evolution of the clinical profile of patients with acute heart failure treated in Spanish emergency departments.
abstract: OBJECTIVE
  To analyse the changes in epidemiology, outpatient and emergency department clinical care, and outcomes of patients treated for acute heart failure (AHF) in Spanish hospital emergency departments (HEDs) between 2007 and 2014.
  
  
  METHODS
  A multicentre cohort study was conducted that consecutively included patients with AHF diagnosed in 9HEDs during 4 periods (2007, 2009, 2011 and 2014). The study analysed the changes observed in 20 variables corresponding to baseline data, outpatient care and emergency care data and outcome data.
  
  
  RESULTS
  A total of 4,845 patients were included. There were significant changes in 13 variables: there was an increase in patients older than 80years (2007/2014: 45.9%/55.4%; P<.001) and a decrease in severe functional dependence (28.2%/19.7%; P<.001). In terms of long-term outpatient care, there was an increased use of beta-blockers (44.6%/57.8%; P=.002) and aldosterone antagonists (26.6%/37.7%; P<.05) among patients with reduced ejection fraction and an increase use of echocardiography (42.8%/56.2%; P=.001). The use of digoxin decreased (25.4%/16.9%; P=.005). In terms of emergency care, there was an increase in requests for troponins (54.6%/61.9%; P<.001), natriuretic peptides (7.8%/48.5%; P<.001) and the use of noninvasive ventilation (3.2%/6.9%; P=.004). Requests for endovenous perfusion drugs decreased (diuretics: 21.3%/10.4%; P<.001; nitrates: 21.3%/17.5%; P=.001; vasopressors: 4.2%/1.5%; P<.001). Finally, discharges directly from the emergency department without hospitalization increased (20.0%/25.9%; P<.001), and emergency department readmissions at 30days decreased (27.3%/17.6%; P=.007). Hospital mortality and mortality at 30days did not change.
  
  
  CONCLUSIONS
  Changes in outcomes were detected during a 7-year period in patients with AHF treated in HEDs, with care that was more in line with the clinical guidelines. There are, however, areas for improvement. There was a noteworthy increase in outpatient follow-up without hospitalisation and a reduction in HED readmissions.
authors.affiliation: Área de Urgencias, Hospital Clínic; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España.
authors.forename: R
authors.initials: R
authors.lastname: Escoda
authors.affiliation: Área de Urgencias, Hospital Clínic; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España.
authors.forename: Ò
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Servicio de Urgencias, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España.
authors.forename: F J
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.affiliation: Servicio de Urgencias, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: P
authors.initials: P
authors.lastname: Herrero
authors.affiliation: Área de Urgencias, Hospital Clínic; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España.
authors.forename: V
authors.initials: V
authors.lastname: Gil
authors.affiliation: Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Garrido
authors.affiliation: Servicio de Urgencias, Hospital La Fe, Valencia, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez-Durá
authors.affiliation: Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España.
authors.forename: M
authors.initials: M
authors.lastname: Fuentes
authors.affiliation: Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Departamento de Medicina Clínica, Universidad Miguel Hernández; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-FISABIO), Alicante, España. Electronic address: llorens_ped@gva.es.
authors.forename: P
authors.initials: P
authors.lastname: Llorens
keywords: Acute heart failure; Emergency department; Insuficiencia cardiaca aguda; Mortalidad; Mortality; Readmission; Reconsulta; Tratamiento; Treatment; Urgencias