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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. |
Note: | Reproducció del document publicat a: https://europepmc.org/article/med/33978329 |
It is part of: | Emergencias, 2021, vol. 33, num. 3, p. 165-173 |
URI: | http://hdl.handle.net/2445/199507 |
ISSN: | 1137-6821 |
Appears in Collections: | Articles publicats en revistes (Ciències Clíniques) |
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