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Martín-Sánchez FJ, Parra Esquivel P, Llopis García G, González Del Castillo J, Rodríguez Adrada E, Espinosa B, López Díez MP, Romero Pareja R, Rizzi Bordigoni MA, Pérez-Durá MJ, Bibiano C, Ferrer C, Aguiló S, Martín Mojarro E, Aguirre A, Piñera P, López-Picado A, Llorens P, Jacob J, Gil V, Herrero P, Fernández Pérez C, Gil P, Calvo E, Rosselló X, Bueno H, Burillo G, Miró Ò. Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial. Emergencias 2021; 33:165-173. [PMID: 33978329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. MATERIAL AND METHODS Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. RESULTS We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%). CONCLUSION Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Guillermo Llopis García
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Begoña Espinosa
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España
| | - María Pilar López Díez
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Burgos, Burgos, España
| | | | | | | | - Carlos Bibiano
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Vallecas, Madrid, España
| | - Carles Ferrer
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | | | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital Reina Sofía, Murcia, España
| | - Amanda López-Picado
- Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital de Santa Tecla, Tarragona, España
| | - Cristina Fernández Pérez
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Enfermería, Universidad de Enfermería, Madrid, España
| | - Pedro Gil
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Geriatría, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Elpidio Calvo
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), España
| | - Xavier Rosselló
- Servicio de Cardiología, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
| | - Guillermo Burillo
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
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