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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Acute heart failure in the emergency department: current trends in management
Session:
Posters 3 - Écran 06 - IC - Prognóstico
Speaker:
Patrícia M. Alves
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Posters
FP Number:
---
Authors:
Patrícia M. Alves; Ana Vera Marinho; José Paulo Almeida; Tatiana Gonçalves; Susana Costa; Fátima Franco Silva; Rui Baptista; Mariano Pêgo
Abstract
<p>BACKGROUNG: Although acute heart failure (AHF) remains an important public health issue, management has not changed significantly in the past decades. The initial approach in the emergency department (ED) is being increasingly emphasized. We studied the association of early ED management and prognosis in patients with AHF.</p> <p>METHODS: We retrospectively included all 870 patients admitted in our ED with AHF from November 2016 to October 2017. Baseline clinical and analytical data were collected. Outcomes regarding overall mortality, in-hospital mortality, admission and readmissions were determined. Patients were followed-up over a median period of 7 [IQR 2.8-9.9] months (all patients had a minimum follow up of one month).</p> <p>RESULTS: The mean age was 78±10.5 years and 51% were male. The prevalence of valvular heart disease was 38%, coronary artery disease was 27% and atrial fibrillation 69%. Mean left ventricular ejection fraction (LVEF) was 42.5±12.6% and median BNP was 500 [IQR 275-1014] pg.ml<sup>-1</sup>. At admission, 92% presented with a B profile (wet and warm), 2.4% a C profile and 1.15% a L profile, whereas 7% in acute pulmonary edema (APE). The median door-to-furosemide time was 90 [IQR 50-240] minutes; 5% received intravenous nitrates and 6% noninvasive ventilation. About 45% were discharged from the ED. Overall mortality was 21%, in-hospital mortality 13% and the all-cause readmission rates were 32% (10.5% at 30 days). BNP emerged as the best predictor of outcome (readmission and mortality) (HR 1.6, 95%CI 1.4-1.8, p<0.001). Age (OR 1.06, 95%CI 1.02-1.09, p=0.001), BNP (OR 1.4, 95%CI 1.06-1.97, p=0.021), creatinine (OR 1.4, 95%CI 1.07-1.9, p=0.018), LVEF (OR 0.96, 95%CI 0.94-0.98, p=0.002) and APE at admission (OR 2.8, 95%1.2-6.6, p=0.028) were predictors of in-hospital mortality. No significant predictors were found for readmission. However, patients that received furosemide within the first 60 minutes of admission had a lower readmission rate than those with latter administration timings (10 vs 20%; OR 0.7, 95% 0.54-0.82, p=0.04).</p> <p>CONCLUSIONS: In-hospital mortality and readmission rates were considerable in this cohort of elderly patients with AHF. Clinical and analytical status at admission in the ED were important predictors of poor prognosis. Rapid administration of loop diuretics was associated with smaller readmission rates.</p>
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