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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
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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
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A real-world analysis of acute decompensated heart failure outcomes in more than 1000 patients in Portugal: a lower 30-day readmission rate than expected
Session:
Posters 5 - Écran 5 - Insuficiência Cardíaca
Speaker:
Patrícia M. Alves
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:
Patrícia M. Alves; Ana Vera Marinho; José Paulo Almeida; Tatiana Gonçalves; Marta F. Costa; Mafalda Ferreira; Rui Baptista; Susana Costa; Fátima Franco Silva; Isabel Fonseca; Lino Gonçalves
Abstract
<p>BACKGROUND: Acute decompensated heart failure (ADHF) is the first cause of hospitalization among elderly patients. We aimed to characterize the characteristics and outcomes of a large contemporaneous cohort of ADHF patients admitted to our emergency department (ED).</p> <p>METHODS: We conducted a retrospective, observational study of all 1057 patients admitted to our ED with a discharge diagnosis of ADHF from November 2016 to December 2017. Baseline clinical data and outcomes (in-hospital, 30-day and follow-up (median period of 5 [IQR 3-11] months) all-cause mortality and readmissions) were determined.</p> <p>RESULTS: Mean age was 78±10 years and 53% were male; of the 1057 patients, half (53%) were hospitalized. The median admission length was 9 [IQR 5-15] days and in-hospital mortality was 12.7%. Median BNP values were 739 [IQR 381-1486] pg/mL and mean creatinine 1.43±0.8 mg/dL. After discharge, all-cause readmission at 30 days was 8% and related to previous admission length [higher with shorter previous admission length (< 5 days), lower with 5-10 days and again higher with admission length above 10 days] (Figures 1 and 2). All-cause mortality at 30 days was 15%, with age [HR 1.4 (95%CI 1.1-1.9), p=0.04] and creatinine [HR 2.3 (95%CI 1.3-5.3), p=0.04] as positive predictors. Follow-up (median 5 month) readmission rate for previously hospitalized patients was 30% and its only predictor was left ventricular ejection fraction (LVEF) [HR 0.93 (95%CI 0.91–0.96), p=0.05]. Follow-up all-cause mortality was 28% and was predicted by age [HR 1.4 (95%CI 1.2-1.7), p<0.01] and creatinine [HR 1.5 (95%CI 1.1 – 1.9), p<0.01]. Of the 47% patients that were directly discharged from the ED, 14% were readmitted at 30 days. Predictors for 30-day readmission were BNP [OR 1.5 (95%CI 1.1-1.8), p=0.02] and C-reactive protein (CRP) [HR 1.9 (95%CI 1.2-1.8), p=0.01]. In this group, 30-day mortality was 5% and only predicted by creatinine [HR 2.5 (95%CI 1.1-4.8), p=0.04]. Follow-up all-cause readmission was 32% and predicted by LVEF [HR 0.91 (95%CI 0.90–0.93), p<0.01]; all-cause mortality was 15% and was predicted by CRP [HR 1.15 (95%CI 1.0–1.3), p<0.01] and BNP [HR 1.3 (95%CI 1.1–1.5), p<0.01]. Comparing the characteristics of admitted vs discharged ADHF patients, patients with a prior hospitalization had a lower 30-day readmission rate (8% vs 14%, p=0.01), same overall readmission rate (30% vs 32%), but a higher 30-day mortality (15% vs 5%, p<0.01) and overall mortality (28% vs 15%, p<0.01). Admissions were higher during the winter season (figure 3). Only a minority of ED readmissions was discharged (figure 4).</p> <p>CONCLUSIONS: Half of patients admitted to the ED were hospitalized. Of these, only 8% are readmitted within 30 days. In-hospital mortality is high. Among discharged patients directly from the ED, 1 in 7 were readmitted at 30-days. We also report a very high seasonality regarding ADHF admission rate.</p>
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