title: Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study.
abstract: To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea.
  
  
  
  Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM).
  
  
  
  46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014.
  
  
  
  Patients with an ED diagnosis of heart failure.
  
  
  
  Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality).
  
  
  
  455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4-9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled β-agonists (13%) and corticosteroids (6%).
  
  
  
  In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.
authors.affiliation: Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.|School of Medicine, Bond University, Gold Coast, Queensland, Australia.|School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Gerben
authors.identifier: 0000-0003-1100-4552
authors.initials: G
authors.lastname: Keijzers
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Australia and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.|Faculty of Medicine, University of Queensland and Faculty of Heath, Queensland University of Technology, Herston, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Queensland, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Klim
authors.affiliation: Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Colin A
authors.identifier: 0000-0002-4381-7470
authors.initials: CA
authors.lastname: Graham
authors.affiliation: Department of Emergency, Monash Medical Centre, Clayton, Victoria, Australia.|School of Clinical Sciences, Monash University, Clayton, Australia.|Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Craig
authors.affiliation: Department of Emergency Medicine, National University Health System, Singapore, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.|University of New South Wales (Southwest Clinical School), Sydney, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.affiliation: Director, Industry Doctoral Training Centre, ATN Universities, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Lawoko
authors.affiliation: Department of Emergency Medicine, Tours University Hospital, Paris, France.
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009566:Nitrates / Q000627:therapeutic use; D063087:Noninvasive Ventilation; D011446:Prospective Studies; D012042:Registries
chemical_list: D004232:Diuretics; D009566:Nitrates
keywords: ACCIDENT & EMERGENCY MEDICINE