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CPC 2019
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
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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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Management of acute heart failure syndromes in the emergency department in more than 1000 patients
Session:
Posters 3 - Écran 7 - Insuficiência Cardíaca
Speaker:
Marta Costa
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Marta F. Costa; Mafalda Ferreira; Patrícia M. Alves; Ana Vera Marinho; J Almeida; Rui Baptista; Armando Carvalho; Isabel Fonseca; Lino Gonçalves
Abstract
<p>BACKGROUND: The treatment of acute decompensated heart failure (ADHF) has not changed significantly in the past decades, despite the importance of this condition as a public health issue. We aimed to characterize a large population of ADHF patients admitted to a tertiary emergency department (ED) and to follow the management of patients once admitted to the ED.</p> <p>METHODS: We conducted a retrospective, observational study including 1057 patients admitted with ADHF in our ED from November 2016 to December 2017. A diagnosis was considered when ADHF was coded as the primary discharge or admission diagnosis. Patients were followed-up over a median period of 5 [IQR 3-11] months. Baseline clinical and analytical data were collected.</p> <p>RESULTS: The mean age was 78±10 years; there was an equilibrate distribution between male (53%) and female (47%) patients. The prevalence of coronary artery disease was 29%, valvular heart disease 42% and atrial fibrillation 67%. Mean left ventricular ejection fraction (LVEF) was 43±13%. Mean serum creatinine was 1.3±0.7 mg/dL, mean reactive C-protein (CRP) 3.3±2.1 mg/dL and median B-type natriuretic peptide (BNP) 545 [IQR 296-1131] pg/mL. At the ED, 92% of patients received intravenous diuretics, 5% intravenous vasodilators (mainly dinitrate isosorbide), 5% underwent noninvasive ventilation and 1% received inotropic support. The median time from door-to-furosemide administration was 90 [IQR 40-230] minutes. Of the 1057 patients, 47% were discharged within the first 12 hours of ED stay. Patients that were admitted to the hospital were predominantly male (56% vs 47%, p<0.001), younger (77±9 vs 79±11 years, p=0.002), with higher creatinine values (1.4±0.8 vs 1.2±0.7 mg/dL, p<0.001), BNP 545 [IQR 296-1131] pg/mL and CRP (2.5±1.7 vs 2.7±1.4 mg/dL, p=0.021) levels. Male gender (OR 1.62, 95%CI 1.4-1.9, p=0.018), BNP levels (OR 1.81, 95%CI 1.47-2.1, p<0.001) and LVEF (OR 0.96, 95%CI 0.94-0.98, p<0.001) were significant predictors of admission versus discharge. Mean admission length was 12 ± 9 days. In-hospital mortality was 13%.</p> <p>CONCLUSIONS: ADHF is responsible for a significant number of ED visits, with half of patients being admitted to the hospital. Acute pharmacological management in the ED was suboptimal, with a very low usage of intravenous vasodilators; also, a delayed administration of loop diuretics was seen. The clinical and analytical status in the ED were important predictors of in-hospital admission.</p>
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