Outcomes of acute heart failure patients managed in the emergency department.

IF 2 4区 医学 Q2 EMERGENCY MEDICINE Canadian Journal of Emergency Medicine Pub Date : 2023-09-01 Epub Date: 2023-08-03 DOI:10.1007/s43678-023-00555-6
Jessica Poliwoda, Debra Eagles, Krishan Yadav, Marie-Joe Nemnom, Charlotte Grace Walmsley, Lisa Mielniczuk, Ian G Stiell
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引用次数: 1

Abstract

Background: Acute heart failure is a serious condition commonly seen in the emergency department (ED). The HEARTRISK6 Scale has been recently developed to identify the risk of poor outcomes but has not been tested. We sought to describe the management and outcomes of ED patients with acute heart failure and to evaluate the potential impact of the HEARTRISK6 Scale.

Methods: We conducted a health records review of 300 consecutive acute heart failure patients presenting to two tertiary care EDs. Two evaluators abstracted clinical variables, ED management and treatment details, and patient outcomes using the electronic health records platform (EPIC) and attending physicians verified the data. The primary outcome measure was a short-term serious outcome, as shown in Results. In addition, the HEARTRISK6 score was calculated retrospectively.

Results: We included 300 patients with mean age of 78.5 years, 51.0% male, 56.3% arrival by ambulance, and 67.0% admitted to hospital. 25.3% experienced a short-term serious outcome 1) after admission (N = 201): non-invasive ventilation 14.9%, intubation 1.5%, major cardiac procedure 5.0%, myocardial infarction 2.0%, death 8.5%; 2) after ED discharge (N = 99): return to ED 21.2%, death 4.0%. Those initially admitted experienced a much higher proportion of serious outcomes compared to those discharged (29.9% vs. 16.2%). A HEARTRISK6 Scale cut-point score of ≥ 1 would have had a sensitivity of 91.0%, specificity 24.5%, and negative likelihood ratio 0.37 for short-term serious outcomes and suggested hospital admission for 80.7% of cases.

Conclusion: There was a large range of severity of illness of acute heart failure patients and a wide variety of treatments were administered in the ED. Both admitted and discharged patients experienced a high proportion of poor outcomes. The HEARTRISK6 Scale showed a high sensitivity for short-term serious outcomes but with the potential to increase hospital admissions. Further validation of the HEARTRISK6 Scale is required before routine clinical use.

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急诊科管理的急性心力衰竭患者的结果。
背景:急性心力衰竭是急诊科常见的严重疾病。HEARTRISK6量表是最近开发的,用于确定不良结果的风险,但尚未进行测试。我们试图描述急性心力衰竭ED患者的管理和结果,并评估HEARTRISK6量表的潜在影响。方法:我们对300名连续接受两次三级护理ED的急性心力衰竭患者进行了健康记录审查。两名评估人员提取了临床变量、ED管理和治疗细节,以及使用电子健康记录平台(EPIC)和主治医师验证数据的患者结果。主要的结果指标是短期严重结果,如结果所示。此外,对HEARTRISK6评分进行了回顾性计算。结果:我们纳入了300名患者,平均年龄78.5岁,51.0%为男性,56.3%由救护车抵达,67.0%入院。25.3%的患者入院后出现短期严重后果(1)(N = 201):无创通气14.9%,插管1.5%,主要心脏手术5.0%,心肌梗死2.0%,死亡8.5%;2) ED放电后(N = 99):恢复ED 21.2%,死亡4.0%。与出院者相比,最初入院的患者出现严重后果的比例要高得多(29.9%对16.2%) ≥ 1对短期严重后果的敏感性为91.0%,特异性为24.5%,负似然比为0.37,建议80.7%的病例入院。结论:急性心力衰竭患者的病情严重程度各不相同,急诊科采用了多种治疗方法。入院和出院患者的不良结局比例都很高。HEARTRISK6量表显示出对短期严重后果的高度敏感性,但有可能增加住院人数。在常规临床使用之前,需要对HEARTRISK6量表进行进一步验证。
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来源期刊
Canadian Journal of Emergency Medicine
Canadian Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
2.90
自引率
12.50%
发文量
171
审稿时长
>12 weeks
期刊介绍: CJEM is a peer-reviewed journal owned by CAEP. CJEM is published every 2 months (January, March, May, July, September and November). CJEM presents articles of interest to emergency care providers in rural, urban or academic settings. Publishing services are provided by the Canadian Medical Association.
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