Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure

• Published in: Clinical research in cardiology Vol. 107; no. 10; pp. 897 - 913
• Main Authors: Llorens, Pere, Javaloyes, Patricia, Martín-Sánchez, Francisco Javier, Jacob, Javier, Herrero-Puente, Pablo, Gil, Víctor, Garrido, José Manuel, Salvo, Eva, Fuentes, Marta, Alonso, Héctor, Richard, Fernando, Lucas, Francisco Javier, Bueno, Héctor, Parissis, John, Müller, Christian E., Miró, Òscar
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2018; Springer Nature B.V
• Subjects: Acute Disease; Aged, 80 and over; Cardiology; Cardiomyopathy; Dependence; Disease Progression; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Emergency vehicles; Female; Fibrillation; Follow-Up Studies; Heart; Heart diseases; Heart failure; Heart Failure - epidemiology; Heart Failure - therapy; Hospital Mortality - trends; Hospitalization - trends; Humans; Hypertension; Male; Medicine; Medicine & Public Health; Morbidity - trends; Original Paper; Patients; Phenotypes; Prognosis; Prospective Studies; Registries; Spain - epidemiology; Statistical analysis; Survival Rate - trends; Time Factors; Trends; Universe; Ventricle; Registry; Epidemiology; Outcome; Mortality; Acute heart failure
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-018-1261-z

Objectives
To analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007–2016).
Methods
The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries.
Results
Compared to other large registries, our patients were older [80 (10) years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6) days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period.
Conclusions
The EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.