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Title: 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
Author: Martín Sánchez, Francisco Javier
Parra Esquivel, Patricia
Llopis García, Guillermo
González del Castillo, Juan
Rodriguez Adrada, Esther
Espinosa, Begoña
López Diez, Maria Pilar
Romero Pareja, Rodolfo
Rizzi Bordigoni, Miguel Alberto
Pérez-Durá, Maria José
Bibiano, Carlos
Ferrer, Carles
Aguiló, Sira
Martín Mojarro, Enrique
Aguirre Tejedo, Alfons
Piñera, Pascual
López-Picado, Amanda
Llorens, Pere
Jacob, Javier
Gil, Víctor
Herrero Puente, Pablo
Fernandez Pérez, Cristina
Gil, Pedro
Calvo, Elpidio
Rossello, Xavier
Bueno, Hector
Burillo Putze, Guillermo
Miró i Andreu, Òscar
Keywords: Insuficiència cardíaca
Persones grans
Serveis d'urgències hospitalàries
Heart failure
Older people
Hospital emergency services
Issue Date: 1-Jun-2021
Publisher: Saned
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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It is part of: Emergencias, 2021, vol. 33, num. 3, p. 165-173
ISSN: 1137-6821
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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