The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

Pia Harjola*, Tuukka Tarvasmäki, On Behalf of the EURODEM Study Group, Cinzia Barletta, Richard Body, Jean Capsec, Michael Christ, Luis Garcia-Castrillo, Adela Golea, Mehmet A. Karamercan, Paul Louis Martin, Òscar Miró, Jukka Tolonen, Oene van Meer, Ari Palomäki, Franck Verschuren, Veli Pekka Harjola, Said Laribi, Patrick Plaisance, Ghanima Al DandachiMaxime Maignan, Dominique Pateron, Christelle Hermand, Cindy Tessier, Pierre Marie Roy, Lucie Bucco, Nicolas Duytsche, Pablo Garmilla, Giorgio Carbone, Roberto Cosentini, Sorana Truță, Natalia Hrihorișan, Diana Cimpoeșu, Luciana Rotaru, Alina Petrica, Mariana Cojocaru, Silvia Nica, Rodica Tudoran, Cristina Vecerdi, Monica Puticiu, Titus Schönberger, Constant Coolsma, Maarten Baggelaar, Noortje Fransen, Crispijn van den Brand, Doutsje Idzenga, Maaike Maas, Myriam Franssen, Charlotte Mackaij Staal, Joyce Jansen, Marna Bouwhuis

*Corresponding author for this work

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Abstract

Background: Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods: This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results: Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion: Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.

Original languageEnglish
Article number27
JournalBMC Emergency Medicine
Volume22
Issue number1
DOIs
Publication statusPublished - 14 Feb 2022

Bibliographical note

Funding Information:
PH has received funding from Department of Emergency Medicine and Services, Helsinki University Hospital for the analysis of the data and the writing of the manuscript. For the remaining authors none were declared. Open access is funded by Helsinki University Library.

Publisher Copyright: © 2022, The Author(s).

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