BMC Emergency Medicine (Feb 2022)

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,
  • 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,
  • On Behalf of the EURODEM Study Group

DOI
https://doi.org/10.1186/s12873-022-00574-z
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 10

Abstract

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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 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.

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